Clinical Recurrence of Pericarditis in Patients on Corticosteroids vs Standard Anti-Inflammatory Therapy

Methods This is a retrospective comparative effectiveness study. We considered 372 adult patients with recurrent pericarditis who presented at Cleveland Clinic for RP treatment from May 2007 to January 2020 and divided them into two groups. Group 1: Recurrent pericarditis patients treated with CS ± NSAIDs and/or Colchicine for at least 3-6 months from the time of first presentation at Cleveland Clinic (CCF). Group 2: RP patients treated with NSAIDs and/or Colchicine from time of first presentation at CCF for at least 3-6 months. Patients were propensity-matched based on their baseline characteristics into two groups (108 patients each). We studied clinical recurrence in patients on CS versus NSAIDs/colchicine (Median follow-up: Group 1 - 2.7 years, Group 2 - 1.8 years). Results Mean (SD) patient age at presentation was 47 (15) years (range 18 to 85), and 58% were women. During the follow-up, 136 patients had at least one recurrence event. Most recurrences were secondary to CS taper. The recurrence rate in CS-treated patients (Group 182.4%) was significantly higher than in NSAIDs/colchicine-treated patients (Group 2 - 43.5%); p<.008. One-year, three-year, and five-year freedom from recurrence in Group 1 versus Group 2 was 23% vs. 63%, 5.9% vs. 43%, and 2.1% vs. 32%, respectively. Conclusion Prolonged use of CS is a marker of persistent and difficult-to-manage disease.