The Role of Rilonacept in Recurrent Pericarditis

Rilonacept and Other Interleukin-1 Inhibitors in the Treatment of Recurrent Pericarditis

“…This inflammatory milieu further activates NLRP3 causing a vicious cycle responsible for recurrent attacks of pericarditis. 10,19,21,24,25…”

“…This inflammatory milieu further activates NLRP3 causing a vicious cycle responsible for recurrent attacks of pericarditis. 10,19,21,24,25 Figure 1 represents a simplified version of the proposed pathophysiology of recurrent autoinflammatory pericarditis.…”

“…15,16 It has now been shown that recurrent pericarditis in many patients is rather an "autoinflammatory" phenotype, similar to other autoinflammatory diseases such as familial Mediterranean fever (FMF), cryopyrin-associated periodic syndromes (CAPS), and tumor necrosis factor alpha-associated periodic syndrome (TRAPS), where innate immunity plays a central part in the pathogenesis. 5,10,[17][18][19] These autoinflammatory conditions are characterized by recurrent periods of fever, polyarthralgias, polyserositis, and elevated inflammatory markers, without the presence of antigen-specific T cells or autoantibodies. 20 Autoinflammatory conditions share a common underlying pathway involving the formation of inflammasome.…”

“…6,7 Unfortunately, despite optimal treatment, approximately 15-30% of patients with acute pericarditis have a recurrence within 18 months. 6,[8][9][10] Almost half of them do not achieve complete remission and continue to have recurrent flares. [10][11][12] Many of these patients are refractory to colchicine and become corticosteroid-dependent with long-term side effects from steroids.…”

“…6,[8][9][10] Almost half of them do not achieve complete remission and continue to have recurrent flares. [10][11][12] Many of these patients are refractory to colchicine and become corticosteroid-dependent with long-term side effects from steroids. Recurrent pericarditis severely impairs quality of life and is associated with significant morbidity.…”