Lazarou Emilia, Koutsianas Christos, Vlachakis Panayotis K, Theofilis Panagiotis, Vassilopoulos Dimitrios, Tsioufis Costas, Lazaros George, Tousoulis Dimitris
First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece.
Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 114 Vass. Sophias Ave, 11527 Athens, Greece.
Pharmaceuticals (Basel). 2024 Aug 15;17(8):1069. doi: 10.3390/ph17081069.
Refractory recurrent pericarditis is a troublesome condition that severely impairs the quality of life of affected patients and significantly increases healthcare spending. Until recently, therapeutic options included only a few medications and most of the patients resorted to chronic glucocorticoid treatment with steroid dependence. In the most recent decade, the introduction of interleukin-1 blockers in clinical practice has revolutionized the treatment of glucocorticoid-dependent and colchicine-resistant recurrent pericarditis due to their excellent efficacy and good safety profile. The rationale for the introduction of this class of medications in clinical practice is the autoinflammatory nature of recurrent pericarditis in a substantial rate of cases, with interleukin-1 being the main pro-inflammatory cytokine involved in this context. This review aims to discuss the contemporary available evidence from original research and real-world data on interleukin-1 blocker use in refractory recurrent pericarditis, in terms of indications, mechanism of action, efficacy, side effects, and recommended treatment protocols. Moreover, novel treatment proposals, such as hydroxychloroquine, , and cannabidiol, which showed encouraging preliminary results, are addressed. Finally, gaps in knowledge, unmet needs, and future perspectives related to recurrent pericarditis are thoroughly discussed.
难治性复发性心包炎是一种棘手的病症，严重损害患者的生活质量，并显著增加医疗支出。直到最近，治疗选择还仅包括少数几种药物，大多数患者只能采用会导致类固醇依赖的慢性糖皮质激素治疗。在最近十年中，白细胞介素-1阻滞剂引入临床实践，因其卓越的疗效和良好的安全性，彻底改变了糖皮质激素依赖且对秋水仙碱耐药的复发性心包炎的治疗。在相当一部分病例中，复发性心包炎具有自身炎症性质，白细胞介素-1是此背景下主要的促炎细胞因子，这就是将这类药物引入临床实践的理论依据。本综述旨在讨论关于白细胞介素-1阻滞剂用于难治性复发性心包炎的原始研究和真实世界数据中的当代现有证据，内容涉及适应证、作用机制、疗效、副作用及推荐治疗方案。此外，还探讨了显示出令人鼓舞的初步结果的新治疗建议，如羟氯喹和大麻二酚。最后，全面讨论了与复发性心包炎相关的知识空白、未满足的需求及未来展望。
