Anti-IL-1 agents: a paradigm shift in medical therapy for recurrent pericarditis?

Recurrent pericarditis is one of the most troublesome complications of pericarditis, affecting 15%–30% of patients with a first episode of pericarditis1 2 and often severely affecting the quality of life of patients. Colchicine has been demonstrated to be a safe and efficacious treatment to halve the recurrence rate either in acute or recurrent episodes at 18 months also after drug withdrawal after 3–6 months of therapy,1 2 and it is a mainstay of medical therapy in association with non-steroidal anti-inflammatory drugs and/or corticosteroids at low to moderate doses3 according to 2015 European Society of Cardiology guidelines with a class IA indication.4 However, 5%–10% of patients with recurrent pericarditis cannot achieve disease control with a combination of these therapies and may become corticosteroid-dependent and colchicine resistant, often with significant side effects related to the chronic use of corticosteroids.5 For these patients, new therapies are needed beyond traditional approaches, and anti-interleukin (IL)-1 agents, such as rilonacept, have been recently proposed as new drugs in this clinical setting. The current paper6 reports an open-label, single-arm, phase II study evaluating the efficacy and safety of rilonacept in 25 adult patients (mean age 43 years, 60% women) with idiopathic or postpericardiotomy recurrent pericarditis with a least two recurrences and active disease or corticosteroid dependence evaluated at nine sites in the USA from January 2018 to May 2019. Rilonacept is an IL-1 trap active on either IL-1-α and IL-1-β, and was given subcutaneously with a loading dose of 320 mg for the first day followed by a maintenance dose of 160 mg weekly for 6 weeks and extended to an optional time of 18 weeks (total treatment time of 6 months). A single dose of rilonacept was able to reduce either pericarditis pain or C reactive protein (CRP) with a median normalisation …