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Sustained Pericarditis Recurrence Risk Reduction With Long-Term Rilonacept.

Massimo Imazio1, Allan L Klein2, Antonio Brucato3

  • 1Department of Medicine (DMED), University of Udine and Cardiothoracic Department University Hospital Santa Maria della Misericordia, ASUFC Udine Italy.

Journal of the American Heart Association
|March 12, 2024
PubMed
Summary
This summary is machine-generated.

Continued rilonacept treatment effectively managed recurrent pericarditis in the RHAPSODY long-term extension. Suspending treatment at 18 months increased the risk of pericarditis recurrence, highlighting the importance of sustained interleukin-1 inhibition.

Keywords:
autoinflammatory diseaseinterleukin‐1recurrent pericarditisrilonacept

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Area of Science:

  • Cardiology
  • Immunology
  • Pharmacology

Background:

  • Recurrent pericarditis poses a significant clinical challenge.
  • Rilonacept, an interleukin-1 trap, demonstrated efficacy in reducing pericarditis recurrence in the phase 3 RHAPSODY study.
  • The RHAPSODY long-term extension investigated sustained treatment and its impact on disease natural history.

Purpose of the Study:

  • To evaluate the long-term efficacy and safety of rilonacept in patients with recurrent pericarditis.
  • To explore treatment duration decision-making and its association with pericarditis recurrence.
  • To assess the impact of continued rilonacept treatment versus suspension on recurrence rates.

Main Methods:

  • Seventy-four patients from the RHAPSODY study entered the long-term extension.
  • Patients received open-label rilonacept for up to 24 additional months.
  • Treatment decisions (continue, suspend, or discontinue rilonacept) were made at an 18-month milestone post-recurrence.

Main Results:

  • The annualized recurrence rate on rilonacept was significantly lower (0.04 events/patient-year) compared to prestudy rates (4.4 events/patient-year).
  • At the 18-month milestone, 64% of patients continued rilonacept, 15% suspended it, and 21% discontinued.
  • Patients continuing rilonacept had a 98% lower risk of recurrence compared to those who suspended treatment (HR=0.02, P<0.0001).

Conclusions:

  • Continued rilonacept treatment is associated with sustained response and low recurrence rates in recurrent pericarditis.
  • Treatment suspension at the 18-month decision point was linked to a higher incidence of pericarditis recurrence.
  • Sustained interleukin-1 inhibition with rilonacept is crucial for managing recurrent pericarditis.