Acute Pericarditis When Corticosteroids and Colchicine Have Not Achieved Remission
In some patients with acute pericarditis, the combination of corticosteroids and colchicine — including triple therapy with an NSAID — does not lead to clinical remission. This page describes the structured next step when that prior approach has failed.
Prior treatment — goals not reached
What the previous regimen aimed to achieve
The preceding treatment — corticosteroids (with or without an NSAID) plus colchicine — targeted clinical remission: full resolution of chest pain and normalization of C-reactive protein. When these goals are not met, the protocol below is indicated.
Treatment goal at this stage
The target remains clinical remission — complete regression of pericarditis symptoms (chest pain) and normalization of C-reactive protein levels.
Treatment approach at this stage
This protocol uses an anti-IL-1 targeted therapy. Which agent to select, how long to continue, and how to sequence the approach is detailed in the full structured regimen.
Complete agent selection, dosing, and duration are in the full protocol below.
References
- Anti-IL-1 agents (anakinra or rilonacept) are recommended for patients with recurrent pericarditis after failure of first-line therapies and corticosteroids and elevation of C-reactive protein levels to reduce recurrences and allow corticosteroid withdrawal.
- Clinical remission is defined as full regression of symptoms, as well as normalization 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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