Queries on Rilonacept in COVID-19 and Vaccine-Linked Pericarditis: Addressing Study Outcomes

I am writing in response to the recently published manuscript by Dr. Antonio Brucato and colleagues, entitled "Absence of Pericarditis Recurrence in Rilonacept-Treated Patients with COVID-19 and SARS-CoV-2 Vaccination: Results from RHAPSODY Long-Term Extension.1Brucato A. Trotta L. Arad M. et al.Absence of Pericarditis Recurrence in Rilonacept-Treated Patients with COVID-19 and SARS-CoV-2 Vaccination: Results from RHAPSODY Long-Term Extension.CJC Open. 2024; Abstract Full Text Full Text PDF Google Scholar" The study presents compelling data supporting the continued use of rilonacept in the management of recurrent pericarditis (RP) during the concurrent challenges posed by COVID-19 and its vaccinations. While the findings are promising, I would like to raise a few points that could further clarify the implications of this study and address some potential areas for future research.1.Impact of Different COVID-19 Vaccine Types on RP Patients: The manuscript briefly mentions the types of vaccines administered (mRNA, adenovirus, unknown), but there is no detailed analysis of whether the type of vaccine influenced the clinical outcomes of RP patients. Given the differential immune responses elicited by these vaccines, could the authors comment on whether the vaccine type might differentially impact the recurrence of pericarditis?2.Role of Rilonacept During Severe COVID-19 Infections: The study noted that only one severe case of COVID-19 was reported among the cohort, which did not lead to pericarditis recurrence but had a prolonged course. Can the authors speculate or provide insights on the mechanism by which rilonacept might influence outcomes in severe COVID-19 cases, particularly considering its role in cytokine regulation?3.Long-Term Outcomes Post-COVID-19 in RP Patients: While the immediate effects of COVID-19 on pericarditis recurrence were effectively captured, the long-term effects of COVID-19 on RP patients remain unclear. Are there plans to follow up on these patients to monitor the long-term sequelae of COVID-19, especially considering the potential for long COVID symptoms that could affect cardiovascular health? The study is indeed a significant addition to our understanding, particularly highlighted by references such as Imazio et al.2Imazio M. Brucato A. Lazaros G. et al.Anti-inflammatory therapies for pericardial diseases in the COVID-19 pandemic: safety and potentiality.J Clin Med. 2023; 12: 351-362PubMed Google Scholar, who discuss IL-1 blocking in pericardial diseases, Klein et al.3Klein A.L. Cremer P.C. Cremer M. et al.Management of Patients With Pericardial Diseases: Recommendations of The European Society of Cardiology.Eur Heart J. 2021; 42: 3614-3628Google Scholar, which delve into long-term management strategies for RP, and the foundational Rationale and Design of the RHAPSODY trial by Cremer et al.4Cremer P.C. Kumar A. Kontzias A. et al.Complicated Pericarditis: Understanding Risk Factors and Pathophysiology to Inform Imaging and Treatment.J Am Coll Cardiol. 2020; 76: 1747-1762Google Scholar. These references collectively underscore the importance of innovative treatments in managing complex cardiac conditions in the face of emerging global health challenges. I appreciate the opportunity to comment on this study and look forward to the authors' responses, which I believe will provide deeper insights into the management of recurrent pericarditis in these challenging times. Absence of Pericarditis Recurrence in Rilonacept-Treated Patients with COVID-19 and SARS-CoV-2 Vaccination: Results from RHAPSODY Long-Term ExtensionCJC OpenPreviewRilonacept inhibits the interleukin-1 pathway, and extended treatment in patients with recurrent pericarditis reduced recurrence risk by 98% in the Phase 3 trial RHAPSODY long-term extension (LTE). SARS-CoV-2 vaccination/infection may trigger pericarditis recurrence, and in clinical practice, it is unknown whether to continue rilonacept during SARS-CoV-2 infection. This post-hoc analysis of the RHAPSODY LTE aimed to inform rilonacept management in recurrent pericarditis patients vaccinated against SARS-CoV-2 or who contract COVID-19.