Corticosteroids for Recurrent Pericarditis

TLDR

Corticosteroid therapy is common for recurrent pericarditis, yet evidence for high‑dose regimens is weak and they carry significant side‑effect risks. This study aimed to compare the incidence of side effects, recurrences, complications, and hospitalizations between low‑dose and high‑dose prednisone regimens. A retrospective review of 100 patients from two Italian referral centers compared 49 individuals receiving 0.2–0.5 mg kg⁻¹ d⁻¹ to 51 receiving 1.0 mg kg⁻¹ d⁻¹, with initial doses maintained for four weeks before tapering. High‑dose prednisone was linked to a 3.6‑fold increase in severe side effects, recurrences, and hospitalizations, indicating that lower doses should be preferred when steroids are necessary.

Abstract

Background— Corticosteroid use is widespread in recurrent pericarditis, even if rarely indicated, and high doses (eg, prednisone 1.0 to 1.5 mg · kg −1 · d −1 ) are generally recommended, although only weak evidence supports their use with possible severe side effects. The aim of this work was to compare side effects, recurrences and other complications, and hospitalizations of a low- versus high-dose regimen of prednisone for recurrent pericarditis. Methods and Results— A retrospective review of all cases of recurrent pericarditis treated with corticosteroids according to different regimens from January 1996 to June 2004 was performed in 2 Italian referral centers. One hundred patients with recurrent pericarditis (mean age, 50.1±15.8 years; 57 females) were included in the study; 49 patients (mean age, 47.5±16.0; 25 females) were treated with low doses of prednisone (0.2 to 0.5 mg · kg −1 · d −1 ), and 51 patients (mean age, 52.6±15.3; 32 females) were treated with prednisone 1.0 mg · kg −1 · d −1 . Baseline demographic and clinical characteristics were well balanced across the groups. Each initial dose was maintained for 4 weeks and then slowly tapered. After adjustment for potential confounders (age, female gender, nonidiopathic origin), only high doses of prednisone were associated with severe side effects, recurrences, and hospitalizations (hazard ratio, 3.61; 95% confidence interval, 1.96 to 6.63; P <0.001). Conclusions— Use of higher doses of prednisone (1.0 mg · kg −1 · d −1 ) for recurrent pericarditis is associated with more side effects, recurrences, and hospitalizations. Lower doses of prednisone should be considered when corticosteroids are needed to treat pericarditis.