New Medicines May Bring a Halt to Your Recurrent Pericarditis

Drugs that modulate the immune system look promising in clinical trials

If you have recurrent pericarditis, new medications may provide new treatment options that can end episodes of pericarditis.

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Pericarditis is an inflammation of the sac that surrounds the heart, and can be the cause of chest pain in young people. Most cases of pericarditis occur in men ages 20 to 50, although pericarditis also can occur in women. Pericarditis usually develops suddenly and may last up to several months.

Sometimes pericarditis recurs, a serious condition that happens in up to 30 percent of people who develop an initial bout of pericarditis, says cardiologist Allan Klein, MD, Director of Cleveland Clinic’s Center for the Diagnosis and Treatment of Pericardial Diseases. Recurrent pericarditis strikes even young patients — from teenagers to patients in their 20s and 30s.

“Many of my patients can suffer debilitating pain that prevents them from working and even exercising, and that negatively impacts their quality of life,” Dr. Klein says.

A large percentage of these younger patients have a difficult-to-treat form of recurrent pericarditis that resists treatment with the anti-inflammatory drugs, including non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine, Dr. Klein says. These patients may need to add steroids to help manage their disease, which can cause unwanted side effects.

But there is good news for patients with recurrent pericarditis: Recent studies suggest new-generation treatments can end episodes of pericarditis for good.

Why pericarditis happens

Viral infection is the most common cause of acute pericarditis, Dr. Klein says.

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“Ninety percent of my patients have pericarditis following a bout with a virus such as the flu or from unknown causes,” he says.

Pericarditis also can occur after cardiac surgery, trauma to the chest, or a bout of tuberculosis, Dr. Klein says. Autoimmune conditions such as systemic lupus erythematosus or rheumatoid arthritis also can cause pericarditis.

Two new medicines

Specialists now are looking to drugs that modulate the immune system, hoping to stop the recurrent pericarditis rather than just treat the symptoms. They are targeting the inflammasome, which is responsible for the altered immune response in these patients with auto-inflammatory diseases.

Medications such as interleukin receptor blockers, currently used for diseases such as rheumatoid arthritis, act on modulating the immune system’s inflammatory response to a variety of triggers.

A multi-center, retrospective study analyzed anakinra, which is an interleukin 1 Beta recombinant receptor antagonist. Researchers looked at the outcomes of 15 patients who had already received the drug colchicine and the steroid prednisone for recurrent pericarditis.

The results, published in the Journal of Pediatrics, say anakinra reduced inflammatory factors and allowed patients to wean themselves off steroid treatments. Researchers concluded that anakinra was safe and effective in long-term prevention of repeated bouts of pericarditis.

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Researchers in Greece also reported that patients had a dramatic drop in recurrences of pericarditis after receiving treatment with anakinra, according to a letter published in the Annals of Rheumatic Diseases.

And a recent study found that anakinra reduced recurrences compared to placebo over a median of 14 months. This was a double-blind, placebo-controlled randomized withdrawal trial — the gold standard of proof in clinical trials. Researchers studied the effects in patients for whom colchicine no longer worked and were taking steroids.

Another interleukin receptor blocker, a specific human monoclonal IgG1 antibody called canakinumab, may hold promise as well.

Currently, trials are under way in Boston examining canakinumab’s ability to reduce inflammatory factors in the cardiovascular system. Though the study focuses on potential use for conditions such as atherosclerosis, canakinumab might help combat pericarditis as well. Some results are expected to be presented at a cardiology conference later this year.

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