Comparative Efficacy and Safety of Colchicine and Anti-Interleukin-1 Agents in Recurrent Pericarditis: A Pairwise and...

The management of recurrent pericarditis includes colchicine and anti-interleukin-1 agents, given the limited efficacy and adverse effects of NSAIDs and corticosteroids. We conducted a pairwise and network meta-analysis to evaluate the efficacy and safety of colchicine and anti-interleukin-1 agents in recurrent pericarditis.

We conducted a comprehensive search on various databases to retrieve relevant randomized controlled trials. Pairwise meta-analyses were performed in R using the exact Mantel-Haenszel method. We also performed a network meta-analysis with a colchicine group as the comparator.

A total of 6 randomized controlled trials were included in the meta-analysis. The risk of pericarditis recurrence was significantly decreased by colchicine (risk ratio [RR], 0.46 [95% CI, 0.37-0.58]) and anti-interleukin-1 agents (RR, 0.12 [95% CI, 0.03-0.54]) compared with placebo or standard therapy. Colchicine significantly decreased the risk of treatment failure (RR, 0.42 [95% CI, 0.31-0.57]) and pericarditis-related rehospitalization (RR, 0.26 [95% CI, 0.10-0.70]) but did not have a significant impact on the risk of adverse events (RR, 1.06 [95% CI, 0.31-3.62]). Anti-interleukin-1 agents were associated with a significantly increased risk of adverse events (RR, 1.88 [95% CI, 1.60-2.21]). The network meta-analysis showed that anti-interleukin-1 agents were associated with a greater reduction in pericarditis recurrence than colchicine (RR, 0.27 [95% CI, 0.11-0.67]), with no significant difference with respect to adverse events (RR, 1.77 [95% CI, 0.88-3.57]).

Both colchicine and anti-interleukin-1 agents are effective in reducing the risk of recurrent pericarditis. Anti-interleukin-1 agents are associated with more frequent nonserious adverse events, but evidence on serious adverse events remains inconclusive.