Duration of Disease and Long-Term Outcomes in Patients With Difficult-To-Treat Recurrent Pericarditis: A Chronic Condition Treated With Nonsteroidal Anti-Inflammatory Drugs, Colchicine, Corticosteroids, and Anti–Interleukin-1 Agents

Objective: We aimed to investigate the remission rate and disease duration in idiopathic or post–cardiac injury pericarditis and risk factors for disease duration and anti–interleukin-1 (IL-1) agent discontinuation. Methods: This was a multicenter, longitudinal, observational study including 370 patients (51.4% female). The remission rate was the proportion of patients who stopped all pericarditis-related therapies for at least 6 months without recurrences. Results: The median follow-up was 4.9 (interquartile range [IQR] 2.8–8.4) years, and the median age at the end of follow-up was 49 (IQR 37–60) years. A median of 1.1 (IQR 0.6–1.9) recurrences/year and 0.4 (IQR 0.1–0.9) hospitalizations/year were recorded. The remission rate at follow-up was 34.0%, 7% per year. Disease duration was shorter for patients in remission (3.1 years, IQR 1.6–6.2 years) than for those still receiving treatment (4 years, IQR 2.2–7.8; P = 0.02). Use of “guidelines-based therapy” (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.25–2.73; P = 0.02) and colchicine use at first attack (HR 1.51, 95% CI 1.02–2.23; P = 0.038) were protective factors, whereas steroid use was associated with longer disease duration (HR 0.53, 95% CI 0.35–0.81; P = 0.003). Corticosteroids were used in 77.3% of patients, with a median duration of therapy of 1.1 (IQR 0.4–2.6) years. Anakinra was used in 25.9% with a median duration of therapy of 2.4 (IQR 0.9–5.0) years; only 19.8% were able to stop anakinra at the end of observation period. Conclusion: This study reports the largest and longest follow-up in patients with recurrent pericarditis. Guideline adherence from the first attack is associated with a shorter course. The disease was long and impacting in terms of recurrences and hospitalizations, often requiring a long-term treatment, in particular with anti–IL-1 agents.