Recurrent Pericarditis - Anti-IL-1 Therapy — EECC MCQ

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ModeratePericardial DiseaseRecurrent Pericarditis - Anti-IL-1 TherapyEECC

A 45-year-old man with a third episode of idiopathic pericarditis (recurrence after 8 months symptom-free) is on colchicine 0.5 mg twice daily and ibuprofen 600 mg three times daily. His CRP remains elevated at 45 mg/L despite 4 weeks of treatment. He is corticosteroid-dependent (symptoms recur whenever prednisolone is tapered below 15 mg). According to the 2025 ESC Myocarditis/Pericarditis Guidelines, what is the recommended next-line therapy?

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Correct answer: C — Anti-interleukin-1 therapy

The 2025 ESC Myocarditis/Pericarditis Guidelines introduce a structured escalation for recurrent pericarditis: first-line is aspirin/NSAID + colchicine; if refractory, anti-IL-1 agents (anakinra or rilonacept) are now recommended (Class IIa) as preferred over prolonged corticosteroid dependence. Anakinra (daily SC injection) and rilonacept (weekly SC injection) have demonstrated striking efficacy in the AIRTRIP and RHAPSODY trials respectively. They are now positioned ahead of corticosteroids for recurrent/refractory inflammatory pericarditis. Treatment duration is typically ≥12 months with gradual tapering of other anti-inflammatory agents. Pericardiectomy is reserved for truly refractory cases. Apply this conclusion only to the clinical circumstances stated, with appropriate specialist review, contraindication checks, shared decision-making and follow-up. Reassess if the physiology, treatment response or competing risk changes. The competing options would require a different haemodynamic profile, diagnosis, procedural indication or risk balance from the one described here.

Reference: ESC (2025): Guidelines for the Management of Myocarditis and Pericarditis: https://bnf.nice.org.uk/