Corticosteroids for recurrent pericarditis: high versus low doses: a nonrandomized observation.

Area of Science:

• Cardiology
• Internal Medicine
• Pharmacology

Background:

• Corticosteroids are commonly used for recurrent pericarditis despite limited evidence.
• High-dose prednisone regimens are often recommended but associated with severe side effects.
• Current treatment guidelines lack robust data comparing low- versus high-dose prednisone efficacy and safety.

Purpose of the Study:

• To compare the side effects, recurrence rates, and hospitalizations between low-dose and high-dose prednisone regimens in patients with recurrent pericarditis.
• To evaluate the safety and efficacy of different prednisone dosages for managing recurrent pericarditis.
• To provide evidence-based recommendations for optimizing corticosteroid therapy in recurrent pericarditis.

Main Methods:

• Retrospective review of 100 patients with recurrent pericarditis treated between 1996 and 2004 in two Italian centers.
• Patients were divided into two groups: low-dose prednisone (0.2-0.5 mg/kg/day) and high-dose prednisone (1.0 mg/kg/day).
• Doses were maintained for 4 weeks then tapered; outcomes were analyzed after adjusting for confounders.

Main Results:

• High-dose prednisone (1.0 mg/kg/day) was significantly associated with severe side effects, recurrences, and hospitalizations (HR, 3.61; 95% CI, 1.96-6.63; P<0.001).
• No significant differences in baseline characteristics were observed between the low-dose and high-dose groups.
• The study identified a clear link between higher prednisone doses and adverse outcomes in recurrent pericarditis.

Conclusions:

• Higher doses of prednisone (1.0 mg/kg/day) are linked to increased side effects, recurrences, and hospitalizations in recurrent pericarditis.
• Lower doses of prednisone should be considered as a safer alternative when corticosteroids are necessary for treating recurrent pericarditis.
• This study suggests a need to revise current treatment protocols for recurrent pericarditis to favor lower prednisone dosages.