Pretreatment With Corticosteroids Attenuates the Efficacy of Colchicine in Preventing Recurrent Pericarditis: A Multi-centre All-case Analysis

Abstract

Aims Effective prevention of recurrent pericarditis remains an important yet elusive goal. Corticosteroid therapy often needs to be continued for a prolonged period and causes severe side effects. We performed a multi-centre all-case analysis to investigate the efficacy of colchicine in preventing subsequent relapses of pericarditis, and addressed the hypothesis that pretreatment with corticosteroids may attenuate the beneficial effect of colchicine. Methods and results One hundred and forty published and unpublished cases of patients treated with colchicine after at least two relapses of pericarditis were aggregated from European centres. Of those, 119 were included in the study group. Only 18% of the patients had relapses under colchicine therapy, and 30% after its discontinuation. There were significantly more relapses among male patients after colchicine treatment (36 vs. 17%, P ¼ 0.046), and those with previous corticosteroid treatment (43 vs. 13%, P ¼ 0.02). Multivariate logistic regression analysis identified previous corticosteroid therapy (OR 6.68, 95% CI: 1.65-27.02) and male gender (OR 4.20, 95% CI: 1.16-15.21) as independent risk factors for recurrence following colchicine therapy. Conclusion Treatment with colchicine is highly effective in preventing recurrent pericarditis, while pretreatment with corticosteroids exacerbates and extends the course of recurrent pericarditis.

Acute pericarditis: Update on diagnosis and management

“…While initially effective, the use of steroids may promote recurrence and may attenuate the efficacy of colchicine if used first-line. 10 The reasons for this are unclear but it is thought that most cases of idiopathic acute pericarditis are viral in origin and that steroid use may promote viral replication and delay clearance thereby maintaining the trigger for inflammation. 11 For idiopathic pericarditis, they should only be used adjunctively after a trial of NSAIDs and colchicine for patients with recurrent disease.…”

Pericardial Diseases in Elderly Patients

“…Recurrent viral or idiopathic pericarditis is typically managed with an outpatient medical regimen [2,52,54] initially consisting of an NSAIDs and colchicine [15] as glucocorticoids are known to increase the risk of recurrence despite multiple recurrences of pericarditis [56]. Glucocorticoid therapy is, therefore, reserved for patients who are either unable to tolerate NSAIDs or have failed NSAIDs therapy in the past [2].…”

Recurrent pericarditis: current challenges and future prospects

“…However, in the case of so-called idiopathic pericarditis, it is common that an investigation is not renewed with each occurrence. The diagnosis should remain a diagnosis of exclusion, but accounts for 70%-90% of cases in different published series, 10,[14][15][16] with the exception of a small pediatric series (6.7%). 17 The typical causes are infectious (bacterial or viral), neoplastic, autoimmune, postcardiac injury, or drug-induced.…”

“…Indeed, in two-thirds of cases, pericardial involvement is secondary to other causes: radiation, infections, and so on. Primary malignant pericardial neoplasm is a rare cause of recurrent pericarditis: 0% in published series, [14][15][16][17] although it is documented in some clinical cases. 20…”

“…Cases of drug-induced pericarditis are rare, but may be due to different mechanisms: drug-induced lupus erythematosus (procainamide, hydralazine, methyldopa, isoniazid, and phenytoin), hypersensitivity or idiosyncratic reaction (penicillins, amiodarone, methisergide, mesalazine, clozapine, minoxidil, dantrolene, practolol, phenylbutazone, thiazides, streptomycin, thiouracil, streptokinase, p-aminosalicylic acid, sulfa drugs, cyclosporine, bromocriptine, several vaccines, and anti-tumor necrosis factor [TNF] agents) secondary to chemotherapy (anthracycline derivatives, 5-fluorouracil, and cyclophosphamide), scorpion venom, and so on. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]…”