Key result
Rilonacept approval is linked to ~64% of recurrent pericarditis patients intensifying to IL-1 inhibitors over corticosteroids.
Why the study?
Complications of protracted corticosteroid use underscore the need for corticosteroid-sparing strategies in recurrent pericarditis following trial evidence and FDA approval of rilonacept.
How have treatment patterns for recurrent pericarditis changed regarding the use of IL-1 pathway inhibition versus corticosteroids as second-line therapy?
Observational (n=313)
Yes
How have treatment patterns for recurrent pericarditis changed regarding the use of IL-1 pathway inhibition versus corticosteroids as second-line therapy?
In a multicenter registry, IL-1 pathway inhibition has increasingly replaced corticosteroids as second-line therapy for recurrent pericarditis following the FDA approval of rilonacept.
Answers are grounded in this paper and cite their sources.
Highlights a real-world shift toward steroid-sparing strategies in recurrent pericarditis; leaves open.
BACKGROUND: Recurrent pericarditis (RP) guidelines recommend second-line corticosteroids after aspirin/nonsteroidal anti-inflammatory drugs/colchicine, but complications of protracted use underscore the importance of corticosteroid-sparing strategies. OBJECTIVES: Given clinical trial evidence supporting interleukin (IL)-1 pathway inhibition and US Food and Drug Administration approval of rilonacept in RP, the objective was to assess temporal trends in corticosteroid-sparing treatment of RP in a multicenter registry. METHODS: RESONANCE (REgiStry Of the NAtural history of recurreNt periCarditis in pEdiatric and adult patients; NCT04687358) combines retrospective and prospective data from clinical practice into a single observation period. Patients receiving treatment for idiopathic and postprocedural RP were included. Demographics and treatment intensifications were quantified. RESULTS: Of 313 patients with aspirin/nonsteroidal anti-inflammatory drugs/colchicine treatment (median disease duration 1.9 years; 1 preenrollment recurrence), 44% (n = 138) intensified treatment. Before rilonacept approval in RP, 71% (n = 10) of patients intensified to corticosteroids for second-line therapy, and 29% (n = 4) intensified to IL-1 pathway inhibition. After rilonacept approval, the proportion of patients intensifying to second-line IL-1 pathway inhibition increased to 64% by 2023 (n = 27; rilonacept: 57%, anakinra: 7%), whereas the proportion of patients intensifying to corticosteroids decreased to 33% (n = 14), P = 0.02. Approximately 59% (n = 35) of second-line corticosteroid initiators later transitioned to IL-1 pathway inhibition. In patients starting second-line IL-1 pathway inhibition, 5% (n = 3, rilonacept) and 25% (n = 4, anakinra) subsequently used corticosteroids for >30 days. CONCLUSIONS: In RESONANCE, IL-1 pathway inhibition increasingly replaced corticosteroids as second-line therapy. Most patients starting corticosteroids transitioned to IL-1 pathway inhibition; few transitioned from second-line IL-1 pathway inhibition to long-term corticosteroids. These findings may inform treatment algorithms and patient-provider decision-making.
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Cremer et al. (2025) conducted an observational in Idiopathic and postprocedural recurrent pericarditis (n=313). IL-1 pathway inhibition (rilonacept, anakinra) vs. Corticosteroids was evaluated on Proportion of patients intensifying to second-line therapy after rilonacept approval (p=0.02). After rilonacept approval, the proportion of recurrent pericarditis patients intensifying to second-line IL-1 pathway inhibition increased to 64%, while corticosteroid use decreased to 33%.
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