The autoinflammatory side of recurrent pericarditis: Enlightening the pathogenesis for a more rational treatment

Lopalco, Giuseppe; Rigante, Donato; Cantarini, Luca; Imazio, Massimo; Emmi, Giacomo; Venerito, Vincenzo; Fornaro, Marco; Frediani, Bruno; Nivuori, Mariangela; Brucato, Antonio; Iannone, Florenzo

doi:10.1016/j.tcm.2020.04.006

Cited by 39 publications

(34 citation statements)

References 101 publications

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“…Cytokines such as IL1 and TNF-α are well established in the pathogenesis of pericarditis. The elevated levels of these interleukins in the activated inflammatory cascade setting predispose to pericardial inflammation [28]. The current evidence suggests that in addition to other organs, systemic inflammation may also involve the pericardium.…”

Section: Covid-19 Mediated Increased Inflammationmentioning

confidence: 88%

Pericardial Diseases in COVID19: a Contemporary Review

et al. 2021

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Purpose of Review Coronavirus disease 2019 (COVID19) involves the heart, including pericardium. This article reviews the possible pathophysiological mechanisms in pericardial involvement in COVID19 and pericardial manifestations of COVID19. It also summarizes the patients with pericarditis secondary to COVID19 and outlines the contemporary treatment strategies in this patient population. Recent Findings A high degree of suspicion is required to identify the pericardial involvement in COVID19 patients. It is proposed that an underlying hyperinflammatory reaction in COVID19 leads to pericardial inflammation. Acute pericarditis with or without myocardial involvement is diagnosed on clinical presentation, serum inflammatory markers, electrocardiogram, and echocardiogram. Multimodality imaging may also have an additional diagnostic value. Patients are usually managed medically, but some patients develop a life-threatening pericardial tamponade necessitating pericardial drainage. Summary Pericardial involvement is an important clinical manifestation of COVID19 requiring a proper workup. Timely diagnosis and a specific management plan based on the presentation and concomitant organ involvement usually lead to a complete recovery.

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Section: Covid-19 Mediated Increased Inflammationmentioning

confidence: 88%

Pericardial Diseases in COVID19: a Contemporary Review

et al. 2021

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“…The pathophysiology of pericarditis from idiopathic or PCIS etiologies has been further elucidated over the past decade. There is a complex relationship between environmental triggers and the innate and adaptive immune systems that causes the inflammatory sequelae within the pericardium 12 . Patients with pericarditis exhibit an exaggerated inflammatory response, which may be associated with both autoimmune and auto‐inflammatory processes.…”

Section: Pathophysiology Of Pericarditis: Using Targeted Pharmacotherapymentioning

confidence: 99%

Current pharmacotherapy management of children and adults with pericarditis: Prospectus for improved outcomes

et al. 2021

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Pericarditis is the most common inflammatory pericardial disease in both children and adults. Since the 2015 European Society of Cardiology Guidelines for the diagnosis and management of pericardial disease were published, there have been significant updates to management. Pharmacotherapy has been historically reserved for idiopathic pericarditis (IP). However, there has been increasing use of pharmacotherapies, such as anti‐inflammatory therapies, colchicine, and immunotherapies for other causes of pericarditis, such as post‐cardiac injury syndromes (PCIS). Nevertheless, the quality of data varies depending on PCIS or idiopathic etiologies, as well as the adult and pediatric population. High‐dose anti‐inflammatory therapies should be used to manage symptoms associated with either etiology of pericarditis in both adults and children, but do not ameliorate the inflammatory disease process. Choice of anti‐inflammatory should be guided by drug‐drug/disease interactions, cost, tolerability, patient age, and should be tapered accordingly over several weeks to months. Colchicine should be added as adjuvant therapy to anti‐inflammatory therapies in adults and children with IP, as it has been shown to lower the risk of recurrence, reduce pericarditis symptoms, and improve morbidity. Colchicine is also reasonable to add to adults and children with pericarditis secondary to PCIS. Systemic glucocorticoids increase risk of recurrence in adults and children with IP and are reserved for second‐line treatment in acute and recurrent IP; they are generally avoided in PCIS. Immunotherapies are regarded as third‐line for recurrent IP in adults and children. Limited evidence exists to support their use in patients with pericarditis from PCIS. Pharmacovigilance strategies, such as C‐reactive protein and adverse drug event monitoring, are also important toward balancing efficacy and safety of the various strategies used to manage pericarditis in adults and children.

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“…3 This pathogenetic scheme has been confirmed indirectly by the beneficial effect of both colchicine (an indirect inhibitor of the NLRP3 inflammasome) 1,2 and specific IL-1 blockers in patients with recurrent pericarditis (Graphical Abstract). 4,5 The aim of this review is to provide a focused primer for clinicians on the use of anti-IL-1 agents for pericarditis, including their historical…”

Section: Introductionmentioning

confidence: 99%

Anti-interleukin-1 agents for pericarditis: a primer for cardiologists

Imazio

Lazaros

Gattorno

et al. 2021

European Heart Journal

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Anti-interleukin (IL)-1 agents have been developed for the treatment of autoinflammatory and rheumatic conditions, where overproduction of IL-1 is an important pathophysiologic process. IL-1α and IL-1β are the most studied members of the IL-1 family of cytokines and have the strongest proinflammatory effects. A naturally occurring antagonist (IL-1Ra) mitigates their proinflammatory effects. Overproduction of both IL-1α (released by inflamed/damaged pericardial cells) and IL-1β (released by inflammatory cells) is now a well-recognized therapeutic target in patients with recurrent idiopathic pericarditis. Currently, there are three available anti-IL-1 agents: anakinra (recombinant human IL-1Ra), rilonacept (a soluble decoy receptor ‘trap’, binding both IL-1α and IL-1β), and canakinumab (human monoclonal anti-IL-1β antibody). For patients with corticosteroid-dependent and colchicine-resistant recurrent pericarditis with evidence of systemic inflammation, as evidenced by elevated C-reactive protein, the efficacy and safety of anakinra (2 mg/kg/day up to 100 mg/day subcutaneously usually for at least 6 months, then tapered) and rilonacept (320 mg subcutaneously for the first day followed by 160 mg subcutaneously weekly) have been clearly demonstrated in observational studies and randomized controlled clinical trials. Severe side effects are rare and discontinuation rates are very low (<4%). The most common reported side effect is injection site reactions (>50% of patients). In this article, we describe the historical and pathophysiological background and provide a comprehensive review of these agents, which appear to be the most significant advance in medical therapy of recurrent pericarditis in the last 5 years.

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The autoinflammatory side of recurrent pericarditis: Enlightening the pathogenesis for a more rational treatment

Cited by 39 publications

References 101 publications

Pericardial Diseases in COVID19: a Contemporary Review

Pericardial Diseases in COVID19: a Contemporary Review

Current pharmacotherapy management of children and adults with pericarditis: Prospectus for improved outcomes

Anti-interleukin-1 agents for pericarditis: a primer for cardiologists

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