This protocol applies to patients with acute pericarditis whose symptoms have not resolved on first-line anti-inflammatory treatment. When the initial regimen of aspirin or an NSAID plus colchicine fails to achieve clinical remission, a structured escalation approach is indicated.

First-line therapy — insufficient response

The preceding treatment consisted of aspirin or an NSAID (ibuprofen or indomethacin) plus colchicine, with gastroprotection. The required endpoint — full regression of pericarditis symptoms (chest pain) and normalisation of C-reactive protein — was not achieved, warranting escalation to this protocol.

Next-step approach (partial overview)

This protocol introduces corticosteroid-based treatment as the next step when aspirin/NSAID plus colchicine is insufficient. The complete regimen — including agents, dosing strategy, tapering, and combination options — is available via the link below.

Treatment target

Clinical remission: full regression of pericarditis symptoms (chest pain) and normalisation of C-reactive protein.

References

In cases of incomplete response to aspirin/NSAIDs and colchicine, corticosteroids may be added at low to moderate doses as triple therapy.
Low- to medium-dose corticosteroids should be considered for patients with pericarditis only in cases of contraindication/failure of aspirin/NSAIDs and colchicine, or when there is a specific indication to control symptoms and reduce recurrences.
Clinical remission is defined as full regression of symptoms, as well as normalisation of laboratory results (e.g. C-reactive protein, troponin levels) and investigations (ECG, evidence of PEff, CMR evidence of active inflammation).

DOI: 10.1093/eurheartj/ehaf192

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Acute Pericarditis Not Responding to Aspirin/NSAID and Colchicine Therapy

References