Acute Pericarditis When Aspirin and NSAIDs Are Contraindicated — After First-Line Treatment Has Failed
Some patients with acute pericarditis cannot use aspirin or NSAIDs due to contraindications or intolerance. When the alternative first-line regimen in this setting fails to achieve clinical remission, a specific escalation protocol applies.
Clinical Scenario
Aspirin and NSAIDs are contraindicated or not tolerated. In this population, corticosteroids — at low to moderate doses — are used as first-line therapy, combined with colchicine where appropriate.
Previous Treatment — Failure Condition
The preceding approach — exercise restriction combined with low to moderate doses of corticosteroids and colchicine — did not achieve clinical remission: full regression of chest pain and normalisation of C-reactive protein were not reached. This failure is the trigger for escalation to the present protocol.
Escalation Approach (Partial — Full Regimen in Protocol)
The next-step treatment involves a class of anti-IL-1 agents, aimed at reducing recurrences and enabling corticosteroid withdrawal. Specific drug choice, dosing, and duration are detailed in the full structured protocol.
Treatment Goal
Clinical remission — full regression of pericarditis symptoms (chest pain) and normalisation of C-reactive protein.
References
DOI: 10.1093/eurheartj/ehaf192
- When aspirin and NSAIDs are contraindicated, or for specific indications, corticosteroids should be considered at low to moderate doses plus colchicine.
- 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).