Clinical Burden and Unmet Need in Recurrent Pericarditis: A Systematic Literature Review

Allan Klein*, Paul Cremer, Apostolos Kontzias, Muhammad Furqan, Anna Forsythe, Christopher Crotty, Michelle Lim-Watson, Matthew Magestro

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations

Abstract

Inflammation of the pericardium (pericarditis) is characterized by excruciating chest pain. This systematic literature review summarizes clinical, humanistic, and economic burdens in acute, especially recurrent, pericarditis, with a secondary aim of understanding United States treatment patterns and outcomes. Short-term clinical burden is well characterized, but long-term data are limited. Some studies report healthcare resource utilization and economic impact; none measure health-related quality-of-life. Pericarditis is associated with infrequent but potentially life-threatening complications, including cardiac tamponade (weighted average: 12.7% across 10 studies), constrictive pericarditis (1.84%; 9 studies), and pericardial effusion (54.7%; 16 studies). There are no approved pericarditis treatments; treatment guidelines, when available, are inconsistent on treatment course or duration. Most recommend first-line use of conventional treatments, for example, nonsteroidal antiinflammatory drugs with or without colchicine; however, 15–30% of patients experience recurrence. Second-line therapy may involve conventional therapies plus long-term utilization of corticosteroids, despite safety issues and the difficulty of tapering or discontinuation. Other exploratory therapies (eg, azathioprine, immunoglobulin, methotrexate, anakinra) present steroid-sparing options, but none are supported by robust clinical evidence, and some present tolerability challenges that may impact adherence. Pericardiectomy is occasionally pursued in treatment-refractory patients, although data are limited. This lack of an evidence-based treatment pathway for patients with recurrent disease is reflected in readmission rates, for example, 12.2% at 30 days in 1 US study. Patients with continued recurrence and inadequate treatment response need approved, safe, accessible treatments to resolve pericarditis symptoms and reduce recurrence risk without excessive treatment burden.

Original languageEnglish (US)
Pages (from-to)59-69
Number of pages11
JournalCardiology in review
Volume30
Issue number2
DOIs
StatePublished - Mar 1 2022

Funding

Disclosure: Dr Al.K. receives research grant from scientific advisory board Kiniksa Pharmaceuticals Corp. and advisory board Swedish Orphan Dr. A.K. Biovitrum AB, advisory board Pfizer, Inc. Dr P.C. receives advisory board Swedish Orphan Biovitrum AB and advisory board Kiniksa Pharmaceuticals Corp. Dr. A.K. is the consultant and received honoraria from Novartis, Lilly, Kiniksa, within the past 12 months. A.F. and C.C. are the employees (AF current, CC former) of Purple Squirrel Economics, which acted as paid consultants to Kiniksa Pharmaceuticals Corp. M.L.-W. and M.M. are employees of Kiniksa Pharmaceuticals Corp. Dr M.F. declares no conflict of interest.

Keywords

  • acute pericarditis
  • inflammation
  • pericardiectomy
  • recurrent pericarditis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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