Acute recurrent pericarditis: from pathophysiology towards new treatment strategy.

Abstract

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.

• Authors: Patrice Cacoub, Cindy Marques
• Journal: Heart (British Cardiac Society) (Heart) Vol. 106 Issue 14 Pg. 1046-1051 (07 2020) ISSN: 1468-201X [Electronic] England
• PMID: 32238419 (Publication Type: Journal Article, Review)
• Copyright: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Adrenal Cortex Hormones
• Immunosuppressive Agents

Topics

• Adrenal Cortex Hormones (adverse effects, therapeutic use)
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Pericarditis (diagnosis, physiopathology, therapy, virology)
• Recurrence
• Risk Assessment
• Risk Factors
• Treatment Outcome