Comparative Efficacy and Safety of Colchicine and Anti–Interleukin- 1 Agents in Recurrent Pericarditis: A Pairwise and Network Meta- Analysis of Randomized Controlled Trials

BACKGROUND: The management of recurrent pericarditis includes colchicine and anti–interleukin- 1 agents, given the limited efficacy and adverse effects of NSAIDs and corticosteroids. We conducted a pairwise and network meta- analysis to evaluate the efficacy and safety of colchicine and anti–interleukin- 1 agents in recurrent pericarditis. METHODS: We conducted a comprehensive search on various databases to retrieve relevant randomized controlled trials. Pairwise meta- analyses were performed in R using the exact Mantel–Haenszel method. We also performed a network meta- analysis with a colchicine group as the comparator. Downloaded from http://ahajournals.org by on July 3, 2025 RESULTS: A total of 6 randomized controlled trials were included in the meta- analysis. The risk of pericarditis recurrence was significantly decreased by colchicine (risk ratio [RR], 0.46 [95% CI, 0.37–0.58]) and anti–interleukin- 1 agents (RR, 0.12 [95% CI, 0.03–0.54]) compared with placebo or standard therapy. Colchicine significantly decreased the risk of treatment failure (RR, 0.42 [95% CI, 0.31–0.57]) and pericarditis- related rehospitalization (RR, 0.26 [95% CI, 0.10–0.70]) but did not have a significant impact on the risk of adverse events (RR, 1.06 [95% CI, 0.31–3.62]). Anti–interleukin- 1 agents were associated with a significantly increased risk of adverse events (RR, 1.88 [95% CI, 1.60–2.21]). The network meta- analysis showed that anti–interleukin- 1 agents were associated with a greater reduction in pericarditis recurrence than colchicine (RR, 0.27 [95% CI, 0.11–0.67]), with no significant difference with respect to adverse events (RR, 1.77 [95% CI, 0.88–3.57]). CONCLUSIONS: Both colchicine and anti–interleukin- 1 agents are effective in reducing the risk of recurrent pericarditis. Anti interleukin- 1 agents are associated with more frequent nonserious adverse events, but evidence on serious adverse events remains inconclusive.