Rilonacept RHAPSODY Trial — EECC MCQ
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Correct answer: C — RHAPSODY showed that rilonacept (IL-1 trap, biweekly SC injection) rapidly resolved recurrent pericarditis episodes and maintained remission, allowing corticosteroid withdrawal — the FDA approved rilonacept for recurrent pericarditis based on this trial
RHAPSODY was the pivotal phase 3 randomized-withdrawal trial of rilonacept, a subcutaneous IL-1α/IL-1β cytokine trap, in recurrent pericarditis. It was not a colchicine, NSAID or anakinra trial, and it did show benefit from biologic therapy. Rilonacept rapidly improved active recurrent pericarditis with raised inflammatory markers, allowed withdrawal of background oral therapy including corticosteroids, and then maintained remission with far fewer recurrences than placebo during randomized withdrawal. This evidence led to FDA approval of rilonacept for recurrent pericarditis. In UK exam terms, recurrent corticosteroid-dependent/colchicine-resistant inflammatory pericarditis is now recognised as a setting where specialist anti-IL-1 therapy may be considered; note that RHAPSODY maintenance dosing was once weekly subcutaneous rilonacept. Therefore the correct answer is C.
Reference: ESC Guidelines for the management of myocarditis and pericarditis, 2025; and Klein AL et al. Phase 3 Trial of Interleukin-1 Trap Rilonacept in Recurrent Pericarditis, New England Journal of Medicine, 2021. https://academic.oup.com/eurheartj/article/46/40/3952/8234483