Cremer Paul C, Luis Sushil A, Garshick Michael S, Raisinghani Ajit, Weber Brittany, Winnowski Dona, Clair JoAnn, Parameswaran Vidhya, Curtis Allison, Klein Allan L, Paolini John F
Division of Cardiology, Bluhm Cardiovascular Institute, Departments of Medicine and Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
JACC Adv. 2025 Aug 14;4(9):102050. doi: 10.1016/j.jacadv.2025.102050.
Recurrent pericarditis (RP) guidelines recommend second-line corticosteroids after aspirin/nonsteroidal anti-inflammatory drugs/colchicine, but complications of protracted use underscore the importance of corticosteroid-sparing strategies.
Given clinical trial evidence supporting interleukin (IL)-1 pathway inhibition and US Food and Drug Administration approval of rilonacept in RP, the objective was to assess temporal trends in corticosteroid-sparing treatment of RP in a multicenter registry.
RESONANCE (REgiStry Of the NAtural history of recurreNt periCarditis in pEdiatric and adult patients; NCT04687358) combines retrospective and prospective data from clinical practice into a single observation period. Patients receiving treatment for idiopathic and postprocedural RP were included. Demographics and treatment intensifications were quantified.
Of 313 patients with aspirin/nonsteroidal anti-inflammatory drugs/colchicine treatment (median disease duration 1.9 years; 1 preenrollment recurrence), 44% (n = 138) intensified treatment. Before rilonacept approval in RP, 71% (n = 10) of patients intensified to corticosteroids for second-line therapy, and 29% (n = 4) intensified to IL-1 pathway inhibition. After rilonacept approval, the proportion of patients intensifying to second-line IL-1 pathway inhibition increased to 64% by 2023 (n = 27; rilonacept: 57%, anakinra: 7%), whereas the proportion of patients intensifying to corticosteroids decreased to 33% (n = 14), P = 0.02. Approximately 59% (n = 35) of second-line corticosteroid initiators later transitioned to IL-1 pathway inhibition. In patients starting second-line IL-1 pathway inhibition, 5% (n = 3, rilonacept) and 25% (n = 4, anakinra) subsequently used corticosteroids for >30 days.
In RESONANCE, IL-1 pathway inhibition increasingly replaced corticosteroids as second-line therapy. Most patients starting corticosteroids transitioned to IL-1 pathway inhibition; few transitioned from second-line IL-1 pathway inhibition to long-term corticosteroids. These findings may inform treatment algorithms and patient-provider decision-making.
复发性心包炎（RP）指南推荐在使用阿司匹林/非甾体类抗炎药/秋水仙碱后使用二线皮质类固醇，但长期使用的并发症凸显了皮质类固醇节省策略的重要性。
鉴于有临床试验证据支持白细胞介素（IL）-1通路抑制，且美国食品药品监督管理局已批准rilonacept用于RP，本研究旨在评估多中心注册研究中RP皮质类固醇节省治疗的时间趋势。
“复发性心包炎自然病史登记研究（儿科和成人患者；NCT04687358）”（RESONANCE）将临床实践中的回顾性和前瞻性数据合并为一个观察期。纳入接受特发性和手术后RP治疗的患者。对人口统计学和治疗强化情况进行量化。
在313例接受阿司匹林/非甾体类抗炎药/秋水仙碱治疗的患者中（疾病持续时间中位数为1.9年；入组前有1次复发），44%（n = 138）强化了治疗。在rilonacept获批用于RP之前，71%（n = 10）的患者强化使用皮质类固醇进行二线治疗，29%（n = 4）的患者强化使用IL-1通路抑制治疗。在rilonacept获批后，到2023年强化使用二线IL-1通路抑制治疗的患者比例增至64%（n = 27；rilonacept：57%，阿那白滞素：7%），而强化使用皮质类固醇的患者比例降至33%（n = 14），P = 0.02。约59%（n = 35）开始使用二线皮质类固醇的患者后来转而使用IL-1通路抑制治疗。在开始使用二线IL-1通路抑制治疗的患者中，5%（n = 3，rilonacept）和25%（n = 4，阿那白滞素）随后使用皮质类固醇超过30天。
在RESONANCE研究中，IL-1通路抑制作为二线治疗越来越多地取代了皮质类固醇。大多数开始使用皮质类固醇的患者转而使用IL-1通路抑制治疗；很少有患者从二线IL-1通路抑制治疗转为长期使用皮质类固醇。这些发现可能为治疗方案和医患决策提供参考。
