Corticosteroids and immunosuppressive agents for idiopathic recurrent pericarditis

Recurrent pericarditis is a frequent and troublesome complication of acute pericarditis. Aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine are the mainstay of therapy but few data is available on second-line treatment. We retrospectively analyzed 13 patients, 7 females (54%), median age 40 years, with a median of 4 (IQR 1-6) recurrences per patient despite a well conducted first-line treatment and a median follow-up of 59 months (IQR 38-70). Ten patients received corticosteroids as second-line therapy; 6 out of 10 responded to this therapy while 4 needed the addition of azathioprine. Three other patients received an immunosuppressive agent as second-line therapy (azathioprine, methotrexate, mycophenolate mofetyl). Overall, the mean frequency per month (± SD) of pericarditis recurrences was 0.69 (± 0.40) with aspirin/NSAIDs and colchicine, 0.22 (± 0.34) with corticosteroids alone and 0.01 (± 0.04) with immunosuppressive agents (p < 10^-4). Immunosuppressive agents including azathioprine, methotrexate and mycophenolate mofetyl seem efficacious and well tolerated in patients with idiopathic recurrent pericarditis unresponsive to corticosteroids, corticosteroids-dependent or when corticosteroids side effects are judged unacceptable.