New hopes in recurrent pericarditis

After an initial episode of pericarditis, 30 % of the patients will have a reoccurrence. For some patients this will the beginning of a long journey and an important source of disability besides of receiving best practice and standardization of management. For many the aetiology of recurrent pericarditis would remain elusive and therefore the management would be empirical for a number of years.

Recently, however interest has grown in the role of the inflammasomes in the genesis of recurrent pericarditis. It is therefore not surprising that novel therapies targeted to modulate the innate response of the immune system have been developed. As such Interleukin-1 is thought to have an important role in the development of recurrent pericarditis. This original paper from the RHAPSHODY investigators reports on the result of a phase 3 trial on efficacy and safety of rilonacept, an interleukin-1α and interleukin-β trap. All the patients included in the trial had recurrent pericarditis and raised inflammatory markers. Beside of the small number of patients enrolled in each arm of the study the size of the effect of rilonacept was significant in the resolution of symptoms and when used in monotherapy to prevent the recurrences. These are exciting news that also need to be interpreted with caution as the long-term extension for reported side effect is ongoing. Int eh current trial the authors reported adverse events in 74 out of 86 enrolled patients, 4 of them leading to discontinuation and 5 serious adverse events.

In summary, Rilonacept allowed patients rapid recovery and weaning from other therapies including glucocorticoids. We are however yet to learn the definitive role of these novel therapies with time and increasing number of trials and enrolled patients.