Key result
Rilonacept enables rapid transition to monotherapy in ~8 weeks without pericarditis recurrence.
Why the study?
Polypharmacy management of recurrent pericarditis involves long-term therapies with negative effects, and slow tapering of oral therapies is often required to avoid recurrence.
Does transition to rilonacept allow rapid discontinuation of standard oral therapies without recurrence in patients with recurrent pericarditis?
Observational (n=86)
Double-blind
None
Yes
Does transition to rilonacept allow rapid discontinuation of standard oral therapies without recurrence in patients with recurrent pericarditis?
Initiation of rilonacept monotherapy allows rapid and safe discontinuation of conventional multidrug regimens, challenging the standard slow-taper approach in recurrent pericarditis.
Answers are grounded in this paper and cite their sources.
Supports rilonacept monotherapy transition in recurrent pericarditis; hypothesis-generating and requires randomized confirmation before practice change.
OBJECTIVE: Polypharmacy management of recurrent pericarditis (RP) often involves long-term therapies, often with negative effects. Slow tapering of oral therapies is often required to avoid recurrence. A post hoc analysis of the phase III trial Rilonacept inHibition of interleukin-1 Alpha and beta for recurrent Pericarditis: a pivotal Symptomatology and Outcomes Study (RHAPSODY) evaluated investigator approaches to transitioning to IL-1 blockade monotherapy with rilonacept, which was hypothesised to allow accelerated withdrawal of common multidrug pericarditis regimens. METHODS: RHAPSODY was a multicentre (Australia, Israel, Italy, USA), double-blind, placebo-controlled, randomised-withdrawal trial in adults and adolescents with RP. Investigators initiated rilonacept at the labelled dose level and discontinued oral pericarditis therapies during the 12-week run-in; randomised patients received study drug as monotherapy. Time to rilonacept monotherapy was quantified in patients receiving multidrug regimens at baseline who achieved rilonacept monotherapy during run-in. RESULTS: In 86 enrolled patients, mean time to rilonacept monotherapy was 7.9 weeks, with no recurrences. Of these, 64% (n=55) entered on multidrug regimens: non-steroidal anti-inflammatory drugs (NSAIDs) plus colchicine (44% (24/55)), colchicine plus glucocorticoids (24% (13/55)), or NSAIDs, colchicine, plus glucocorticoids (33% (18/55)). Investigators transitioned patients receiving colchicine and glucocorticoids at baseline to rilonacept monotherapy without recurrence regardless of taper approach: sequential (n=14; median, 7.7 weeks) or concurrent (n=17; median, 8.0 weeks). Median time to rilonacept monotherapy was similar regardless of glucocorticoid dose and duration: ≤15 mg/day (n=21): 7.3 weeks; >15 mg/day (n=18): 8.0 weeks; long-term (≥28 days): 7.6 weeks. CONCLUSIONS: Rapid discontinuation of oral RP therapies while transitioning to rilonacept monotherapy was feasible without triggering pericarditis recurrence. TRIAL REGISTRATION NUMBER: NCT03737110.
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Brucato et al. (2022) conducted an observational in Recurrent pericarditis (n=86). Rilonacept was evaluated on Time to rilonacept monotherapy (mean 7.9 weeks). Rilonacept allowed for rapid discontinuation of standard oral therapies to achieve monotherapy in a mean of 7.9 weeks without triggering pericarditis recurrence.
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