Continuously Relapsing Idiopathic Pericarditis After Failure of Immunosuppressive Therapy, IVIG, and IL-1β Antagonist

This protocol addresses patients with idiopathic pericarditis in whom symptoms continue to relapse despite stepwise escalation through immunosuppressive agents, intravenous immunoglobulin, and interleukin-1β receptor antagonist therapy.

When the Prior Treatment Did Not Work

The previous treatment line — which included immunosuppressive agents (azathioprine or methotrexate), intravenous immunoglobulin, or the interleukin-1β receptor antagonist anakinra — aimed to achieve improvement of symptoms. When that goal remains unmet and pericarditis continues to relapse, escalation to this protocol is indicated.

Next-Step Treatment Approach

In continuously relapsing disease that has not responded to prior therapies, a surgical procedure targeting the pericardium is considered for symptomatic relief. The full protocol details and selection criteria are available via the structured regimen below.

Clinical Goals

The aim is symptomatic relief; outcomes are variable, with complete remission achieved in some patients.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1161/CIRCULATIONAHA.111.066365

Finally, pericardiectomy can be undertaken for symptomatic relief in cases of continuously relapsing pericarditis.
The best outcomes have been reported when complete resection of the pericardium is undertaken.
Results have been variable, with some patients experiencing complete remission but others continuing to be plagued with ongoing symptoms after surgical intervention.

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