Usefulness of Novel Immunotherapeutic Strategies for Idiopathic Recurrent Pericarditis

Lotan, Dor; Wasserstrum, Yishay; Fardman, Alexander; Kogan, Michael; Adler, Yehuda

doi:10.1016/j.amjcard.2015.12.012

Cited by 13 publications

(7 citation statements)

References 28 publications

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“…Indeed, these treatments are currently used primarily in steroid-dependent patients and often lead to transforming a corticosteroid dependence to dependence on immunomodulators. 72 Their remarkable efficacy could see them being used in second-line treatment in place of corticosteroids, at least in some patients, after the failure of standard therapy (treatment by aspirin/NSAIDs and colchicine, prolonged and at high doses). This will perhaps facilitate weaning.…”

Section: Resultsmentioning

confidence: 99%

Recurrent pericarditis: current challenges and future prospects

Dauphin¹,

Merlin²,

Chalard³

et al. 2016

RRCC

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Recurrent pericarditis, usually idiopathic, is difficult to treat. Previous etiological studies can eliminate potentially serious causes that require specific treatment. The pathophysiology of "idiopathic" pericarditis involves autoimmunity and autoinflammation in various degrees and is usually caused by a microbacteriological or postinjury trigger. It requires multidisciplinary care to provide individualized treatment to each patient: treatment escalation by increments, then weaning should be guided by clinical examination but also CRP and potential magnetic resonance imaging. The role of immunomodulators, especially anakinra, should be revisited. Their efficacy is remarkable, and they could be considered for second-line treatment, preferably with corticosteroids (at least among certain selected patients), especially after the failure of prolonged and high-dose standard therapy with aspirin/nonsteroidal anti-inflammatory drugs and colchicine.

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Section: Resultsmentioning

confidence: 99%

Recurrent pericarditis: current challenges and future prospects

Dauphin¹,

Merlin²,

Chalard³

et al. 2016

RRCC

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“…7 Virginia Commonwealth University, Richmond, VA, USA. 8 Medstar Heart and Vascular Institute, Washington, DC, USA. 9 Adelphi Values Patient-Centered Outcomes, Boston, MA, USA.…”

Section: Items That Are Not Included In Above Domainsmentioning

confidence: 99%

“…While the impact of RP on patients' health-related quality of life (HRQoL) has been reported in the literature [7][8][9][10][11][12] and is thought to be due to the primary symptom of the condition (e.g., chest pain) and the resulting uncertainty and anxiety about new recurrences, impact on HRQoL has not been explicitly evaluated in previous clinical research. In addition, corticosteroids (CS), despite well-known warnings and precautions in patients with cardio-metabolic comorbidities, are widely used to treat RP [13], putting patients at risk for additional adverse events, including recurrence and steroid dependence [14]; comorbidities associated with chronic CS use may also lead to adverse impacts on HRQoL [15,16].…”

Section: Introductionmentioning

confidence: 99%

Health-related quality of life in patients with recurrent pericarditis: results from a phase 2 study of rilonacept

Lin

Klein

Cella

et al. 2021

BMC Cardiovasc Disord

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Background Impact of recurrent pericarditis (RP) on patient health-related quality of life (HRQoL) was evaluated through qualitative patient interviews and as an exploratory endpoint in a Phase 2 trial evaluating the efficacy and safety of rilonacept (IL-1α/IL-1β cytokine trap) to treat RP. Methods Qualitative interviews were conducted with ten adults with RP to understand symptoms and HRQoL impacts, and the 10-item Patient-Reported Outcomes Measurement Information System Global Health (PROMIS GH) v1.2 was evaluated to determine questionnaire coverage of patient experience. The Phase 2 trial enrolled participants with active symptomatic RP (A-RP, n = 16) and corticosteroid-dependent participants with no active recurrence at baseline (CSD-RP, n = 9). All participants received rilonacept weekly during a 6-week base treatment period (TP) plus an optional 18-week extension period (EP). Tapering of concomitant medications, including corticosteroids (CS), was permitted during EP. HRQoL was assessed using the PROMIS GH, and patient-reported pain and blood levels of c-reactive protein (CRP) were collected at Baseline and follow-up periods. A secondary, descriptive analysis of the Phase 2 trial efficacy results was completed using HRQoL measures to characterize both the impact of RP and the treatment effect of rilonacept. Results Information from qualitative interviews demonstrated that PROMIS GH concepts are relevant to adults with RP. From the Phase 2 trial, both participant groups showed impacted HRQoL at Baseline (mean PROMIS Global Physical Health [GPH] and Global Mental Health [GMH], were lower than population norm average). In A-RP, GPH/MPH improved by end of base TP and were sustained through EP (similar trends were observed for pain and CRP). Similarly, in CSD-RP, GPH/MPH improved by end of TP and further improved during EP, during CS tapering or discontinuation, without disease recurrence (low pain scores and CRP levels continued during the TP and EP). Conclusion This is the first study demonstrating impaired HRQoL in RP. Rilonacept treatment was associated with HRQoL improvements using PROMIS GH scores. Maintained/improved HRQoL during tapering/withdrawal of CS without recurrence suggests that rilonacept may provide an alternative to CS. Trial registration: ClinicalTrials.Gov; NCT03980522; 5 June 2019, retrospectively registered; https://clinicaltrials.gov/ct2/show/NCT03980522.

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“…prednisone 0.2-0.5 mg/kg/day) in cases of incomplete response or recurrences on aspirin/NSAIDs and colchicine. Two recent systematic reviews described the existing evidence for immunosuppressive drugs in idiopathic refractory recurrent pericarditis [7,31]. In the largest reported experience, azathioprine was administered at a dose of 1.5-2.5 mg/kg/day for 13.6 ± 5.1 months in forty-five patients [32].…”

Section: Corticosteroids or Immunosuppressive Agentsmentioning

confidence: 99%

Acute recurrent pericarditis: from pathophysiology towards new treatment strategy

Cacoub

Marques

2020

Heart

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Acute idiopathic or so-called viral pericarditis is a frequent and usually benign disease, although recurrences are frequent. Data strongly suggest the presence of underlying autoinflammatory and/or autoimmune disorders. It has been reported that there is an inflammatory response of the innate immune system typical of ‘autoinflammatory diseases’, predominantly mediated by interleukin-1 (IL-1). This may result from the activation of the inflammasome by a cardiotropic virus or a non-specific agent. The inflammatory response of the adaptive immune system, typical of ‘autoimmune diseases’—mainly mediated by autoantibodies or autoreactive T lymphocytes—seems also involved as anti-heart or anti-intercalated disk autoantibodies were associated with a higher number of recurrences and hospitalisations. Current guidelines recommend that aspirin/non-steroidal anti-inflammatory drugs for a few weeks should be associated to colchicine for 6 months in recurrent pericarditis. In refractory cases, low-dose corticosteroids or immunosuppressive drugs have been proposed with limited efficacy. Growing evidences suggest a place of IL-1 receptor antagonists in the treatment of recurrent pericarditis. Many retrospective studies, one recent randomised placebo-controlled study and data of a real-life large international registry showed the good efficacy of anakinra with a good safety profile. Other IL-1 receptor antagonists showed promising results (canakinumab, rilonacept). However, IL-1 receptor antagonists’ position in the treatment algorithm of recurrent pericarditis needs further evaluation in larger prospective clinical trials to replicate initial findings as well as to assess safety, cost-effectiveness and long-term efficacy.

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Usefulness of Novel Immunotherapeutic Strategies for Idiopathic Recurrent Pericarditis

Cited by 13 publications

References 28 publications

Recurrent pericarditis: current challenges and future prospects

Recurrent pericarditis: current challenges and future prospects

Health-related quality of life in patients with recurrent pericarditis: results from a phase 2 study of rilonacept

Acute recurrent pericarditis: from pathophysiology towards new treatment strategy

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