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Anti-IL-1 agents: a paradigm shift in medical therapy for recurrent pericarditis?
  1. Massimo Imazio1,2
  1. 1 University Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Torino, Italy
  2. 2 Department of Public Health and Pediatrics, University of Torino, Torino, Italy
  1. Correspondence to Professor Massimo Imazio, University Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy; massimo_imazio{at}

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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 …

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  • Contributors MI confirmed that the paper is original and approved for submission. MI is the sole author of this editorial.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MI has been advisory board member for Sobi and Kiniksa.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

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