Current Drug Treatment for Acute and Recurrent Pericarditis

Area of Science:

• Cardiology
• Internal Medicine
• Inflammatory Diseases

Background:

• Pericarditis is the most common pericardial disease, typically benign with initial guideline-directed therapy.
• Recurrence is a frequent complication, influenced by factors like autoimmune etiology, prior glucocorticoid use, and rapid anti-inflammatory drug tapering.

Purpose of the Study:

• To outline current therapeutic strategies for managing pericarditis and its recurrences.
• To detail the stepwise approach to anti-inflammatory and immunomodulatory treatments.

Main Methods:

• Review of guideline-directed therapies for initial pericarditis episodes.
• Description of treatment escalation for recurrent pericarditis.
• Inclusion of advanced therapies for refractory or high-risk cases.

Main Results:

• Initial treatment typically involves high-dose NSAIDs with rapid tapering, alongside colchicine for symptom relief and recurrence reduction (3-6 months).
• Low-dose glucocorticoids are indicated for first recurrence unresponsive to NSAIDs/colchicine or in autoimmune cases, requiring slow tapering.
• Interleukin-1 blockers serve as third-line therapy for glucocorticoid-dependent cases or second-line for those with contraindications or high-risk features.

Conclusions:

• Effective management of pericarditis relies on a tiered therapeutic approach, starting with NSAIDs and colchicine.
• Colchicine is crucial for reducing recurrence rates.
• Advanced therapies, including Interleukin-1 blockers, offer options for complex and refractory cases.