New clinical trials in acute and recurrent pericarditis

Clinical trials in the last decade have improved the quality of evidence to support preventive medical strategies to reduce the risk of recurrences after pericarditis. There are essentially three main strategies: (1) to use full anti-inflammatory doses for the treatment of each attack of pericarditis till symptoms resolution and normalization of markers of inflammation (i.e., C-reactive protein); (2) to limit the use of corticosteroids and, if used, to use low to moderate doses (i.e., prednisone 0.2 to 0.5 mg/kg/day or equivalent) followed by slow tapering; and (3) to add colchicine to improve the response to conventional anti-inflammatory therapies and reduce the risk of recurrences. Recommended regimens include weight-adjusted doses (i.e., 0.5-0.6 mg twice daily for patients weighing >70 kg or 0.5-0.6 mg once daily for patients weighing ≤70 kg for 3 months for acute pericarditis and 6 months for recurrences) without a loading dose to improve patients' compliance. Using these doses and appropriate selection of patients (e.g. to avoid severe renal impairment or adjust doses according to comorbid conditions and concomitant therapies), the drug is well tolerated, may cause reversible gastrointestinal intolerance (mainly diarrhea) in about 8 to 10% of cases but has no severe side effects.