Cardiology, Cardiothoracic Department, Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy.
Expert Opin Drug Saf. 2022 Feb;21(2):183-190. doi: 10.1080/14740338.2021.1960980. Epub 2021 Aug 30.
Recurrent pericarditis is one of the most troublesome complications of pericarditis affecting a substantial amount of patients and often severely impairing the quality of life. Current medical treatments range from non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids to biological agents (anti IL-1 agents, especially anakinra and rilonacept), intravenous immunoglobulins and immunosuppressive treatments. Safety is a major issue to deal with since the disease often affects relatively young or middle-aged patients.
The review is aimed at providing an update on the efficacy and safety of current medical therapies for recurrent pericarditis including most recent advances represented by anti IL-1 agents.
Therapy of recurrent pericarditis has evolved over years leading to a more evidence-based and personalized treatment based on clinical presentation and pathophysiology. The main distinction is between patients with an inflammatory phenotype (e.g. fever, elevation of markers of inflammation, pericardial, and/or pleural effusion) vs. those without an inflammatory phenotype. Colchicine and anti IL-1 agents are especially efficacious and indicated for those with an inflammatory phenotype, while corticosteroids, azathioprine, and immunoglobulins seem more indicated for those without evidence of systemic inflammation.
复发性心包炎是心包炎最麻烦的并发症之一，影响了大量患者，常严重损害生活质量。目前的治疗方法包括非甾体抗炎药（NSAIDs）、秋水仙碱、皮质类固醇、生物制剂（抗 IL-1 制剂，特别是阿那白滞素和利纳西普）、静脉注射免疫球蛋白和免疫抑制治疗。由于疾病常影响相对年轻或中年患者，安全性是一个主要问题。
本综述旨在提供复发性心包炎当前医学治疗的疗效和安全性的最新信息，包括抗 IL-1 制剂等最新进展。
复发性心包炎的治疗多年来不断发展，基于临床表现和病理生理学，治疗更加基于证据和个体化。主要区别在于具有炎症表型的患者（例如发热、炎症标志物升高、心包和/或胸腔积液）与无炎症表型的患者。秋水仙碱和抗 IL-1 制剂对具有炎症表型的患者特别有效且适用，而皮质类固醇、硫唑嘌呤和免疫球蛋白似乎更适用于无全身炎症证据的患者。
