TABLE 5.
Summary of Studies of Exploratory Steroid-Sparing Therapies
| Treatment | Reference and Evidence | N (Mean Age, yr) | Results |
|---|---|---|---|
| AZA | Vianello et al45 RWE | 46 (39.7) | Moderate (31.4%) decrease in recurrence while on treatment in 40 idiopathic RP patientsAZA d/c was possible in 58.6% of 46 patients |
| Brown et al44 RWE | 13 (NR) | Effective recurrent event reduction subsequent to AZA, but patients remained on CS (38% mean lower dose, 3/13 unable to lower CS) | |
| IVIG | Moretti et al46 RWE | 9 (37.6) | Complete remission in 4/9 patients following 1 IVIG cycle; 4/9 recurred, requiring either NSAIDs (2/4) or additional IVIG (2/4)1/9 required pericardial window and long-term immunosuppression |
| Imazio et al24 SLR | 30 (19.7 excluding Moretti 2013) | Recurrence occurred in 26.6% after 1 IVIG cycle22 of 30 patients (73.4%) included were recurrence-free (mean follow-up of 33.1 mo) | |
| ANA | Brucato et al24 RCT (AIRTRIP) | 21 (45.4) | All tapered off CS during open-label part 1 (60 d)Recurrence occurred in 9/10 randomized to PBO (6/9 occurred within 60 d of ANA d/c) and 2/11 randomized to ANA |
| Vassilopoulos et al27 SACTLazaros et al37; Antonatou et al43 | 10 (42) | All on CS at baseline (n = 8) d/c CS5/7 (70%) that d/c ANA relapsed (mean 18 ± 9 d)57% were not able to stop ANA4/5 were restarted on ANA; 1 was treated with NSAID + colchicine | |
| Jain et al39 RWE | 13 (50.9) | 73% tapered off CS71% that d/c ANA had recurrence85% were not able to stop ANA | |
| Finetti et al40 RWE | 15 (16.4) | All tapered off CS33% that d/c ANA had recurrence69% were not able to stop ANA | |
| Imazio et al41 RWE (IRAP) | 50 (41.4) | 55% tapered off CSANA led to recurrence drop from 6/patient to 0.9/patient36% not able to taper off ANA at 28 mo mean follow-up | |
| Mendel et al42 RWE | 7 (NR) | CS were d/c after mean of 4 mo4 patients were able to taper ANA to <7 d/wkNo patient was able to stop ANA | |
| Furqan et al17, metaanalysis | 65 (NR) | Pericarditis recurrence at day 60 of ANA treatment was 7.4% (P < 0.001; 95% CI, 2.7–18.2%)Recurrence at day 180 was 11% (P < 0.001; 95% CI, 4.6–24%)Patients on ANA were able to decrease (92.3%; P < 0.001; 95% CI, 81.0–97.1%) and discontinue (89.3%; P < 0.001; 95% CI, 76.5–95.6%) CS therapy |
AIRTRIP indicates, Anakinra in Recurrent Pericarditis; ANA, anakinra; AZA, azathioprine; CI, confidence interval; CS, corticosteroid; d/c, discontinued or discontinuation; IRAP, International Registry of Anakinra for Pericarditis; IRRP, idiopathic recurrent refractory pericarditis; IVIG, intravenous immunoglobulin; NR, not reported; NSAIDs, nonsteroidal antiinflammatory drugs; PBO, placebo; RRP, recurrent refractory pericarditis; RWE, real-world evidence; SACT, single-arm clinical trial; SLR, systematic literature review.