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Advances in pharmacotherapy for acute and recurrent pericarditis.
Vecchié, Alessandra; Del Buono, Marco Giuseppe; Mauro, Adolfo Gabriele; Cremer, Paul C; Imazio, Massimo; Klein, Allan L; Abbate, Antonio; Dentali, Francesco; Bonaventura, Aldo.
  • Vecchié A; Department of Internal Medicine, ASST Sette Laghi, Varese, Italy.
  • Del Buono MG; Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
  • Mauro AG; Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
  • Cremer PC; Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
  • Imazio M; Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
  • Klein AL; Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia," ASUFC, Udine, Italy.
  • Abbate A; Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
  • Dentali F; Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
  • Bonaventura A; Department of Medicine and Surgery, Insubria University, Varese, Italy.
Expert Opin Pharmacother ; 23(6): 681-691, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1769033
ABSTRACT

INTRODUCTION:

Aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine are first-line treatments for acute and recurrent pericarditis. Drugs blocking the NACHT, leucine-rich repeat, and pyrin domain-containing protein 3 (NLRP3) inflammasome/interleukin-1ß (IL-1ß) axis are beneficial in patients with multiple recurrences. AREAS COVERED In this review, the role of the NLRP3 inflammasome/IL-1ß axis in the pathophysiology of pericarditis is discussed. Updates about novel therapies targeting IL-1 for recurrent pericarditis (RP) and practical considerations for their use are provided. EXPERT OPINION IL-1 inhibitors have been increasingly studied for RP in recent years. NLRP3 inflammasome is a key mediator in the pathophysiology of RP. IL-1ß, its main product, can sustain its own production and feeds local and systemic inflammation. Randomized clinical trials testing anakinra (a recombinant form of the IL-1 receptor antagonist blocking IL-1α and IL-1ß) and rilonacept (an IL-1α and IL-1ß trap) have shown that IL-1 blockade reduces recurrences. These trials also helped in phenotyping patients with RP. Patients with multiple recurrences and signs of pericardial and/or systemic inflammation might benefit from IL-1 blockers in order to interrupt cyclic flares of auto-inflammation. Given this evidence, guidelines should consider incorporating IL-1 blockers.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pericarditis Type of study: Diagnostic study / Experimental Studies / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Expert Opin Pharmacother Journal subject: Pharmacology Year: 2022 Document Type: Article Affiliation country: 14656566.2022.2054327

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pericarditis Type of study: Diagnostic study / Experimental Studies / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Expert Opin Pharmacother Journal subject: Pharmacology Year: 2022 Document Type: Article Affiliation country: 14656566.2022.2054327