International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences.

Acute pericarditis is common, yet uncertainty persists on its treatment. We thus aimed to conduct a comprehensive systematic review on pharmacologic treatments for acute or recurrent pericarditis.
Controlled clinical studies were searched in several databases and were included provided they focused on pharmacologic agents for acute pericarditis or its recurrences. Random-effect odds ratios (ORs) were computed for long-term treatment failure, pericarditis recurrence, rehospitalization, and adverse drug effects.
From 2,078 citations, 7 studies were finally included (451 patients); but only 3 were randomized trials. Treatment comparisons were as follows: colchicine versus standard therapy (3 studies, 265 patients), steroids versus standard therapy (2 studies, 31 patients), low-dose versus high-dose steroids (1 study, 100 patients), and statins versus standard therapy (1 study, 55 patients). Colchicine was associated with a reduced risk of treatment failure (OR = 0.23 [0.11-0.49]) and recurrent pericarditis (OR = 0.39 [0.20-0.77]), but with a trend toward more adverse effects (OR = 5.27 [0.86-32.16]). Overall, steroids were associated with a trend toward increased risk of recurrent pericarditis (OR = 7.50 [0.62-90.65]). Conversely, low-dose steroids proved superior to high-dose steroids for treatment failure or recurrent pericarditis (OR = 0.29 [0.13-0.66]), rehospitalizations (OR = 0.19 [0.06-0.63]), and adverse effects (OR = 0.07 [0.01-0.54]). Data on statins were inconclusive.
Clinical evidence informing decision-making for the management of acute pericarditis and its recurrences is still limited to few, small, and/or low-quality clinical studies. Notwithstanding such major caveats, available studies routinely using nonsteroidal anti-inflammatory agents in both experimental and control groups suggest a beneficial risk-benefit profile for colchicine and a detrimental one for steroids, especially when used at high dosages.
AuthorsMarzia Lotrionte, Giuseppe Biondi-Zoccai, Massimo Imazio, Davide Castagno, Claudio Moretti, Antonio Abbate, Pierfrancesco Agostoni, Antonio L Brucato, Pietro Di Pasquale, Marja Raatikka, Giuseppe Sangiorgi, Antonio Laudito, Imad Sheiban, Fiorenzo Gaita
JournalAmerican heart journal (Am Heart J) Vol. 160 Issue 4 Pg. 662-70 (Oct 2010) ISSN: 1097-6744 [Electronic] United States
PMID20934560 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
CopyrightCopyright © 2010 Mosby, Inc. All rights reserved.
Chemical References
  • Anti-Inflammatory Agents
  • Acute Disease
  • Anti-Inflammatory Agents (therapeutic use)
  • Controlled Clinical Trials as Topic (methods)
  • Humans
  • International Cooperation
  • Pericarditis (drug therapy)
  • Secondary Prevention
  • Treatment Outcome

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