IL-1 pathway inhibition is increasingly replacing corticosteroids as the preferred second-line treatment for recurrent pericarditis, according to real-world registry data from the RESONANCE study. The findings highlight a growing shift toward corticosteroid-sparing strategies in clinical practice, aligning with trial evidence and regulatory approval of targeted therapies.
Guidelines for recurrent pericarditis traditionally recommend corticosteroids after initial therapy with aspirin, nonsteroidal anti-inflammatory drugs, and colchicine. However, the risks associated with long-term steroid use have underscored the need for safer alternatives. The RESONANCE registry, which combines retrospective and prospective patient data, examined treatment intensification patterns in both adult and pediatric patients with idiopathic and postprocedural recurrent pericarditis.
Among 313 patients receiving first-line therapy, 44% required treatment escalation. Before the approval of rilonacept, 71% of patients advancing to second-line therapy were treated with corticosteroids, while only 29% received IL-1 inhibition. By 2023, following rilonacept approval, the treatment landscape had shifted significantly: 64% of patients escalating to second-line therapy received IL-1 inhibition (57% with rilonacept and 7% with anakinra), while corticosteroid use dropped to 33%.
Importantly, more than half of patients who began second-line corticosteroid therapy later transitioned to IL-1 pathway inhibition. In contrast, very few patients who initiated IL-1 inhibitors subsequently required long-term corticosteroid use. These findings demonstrate a marked preference for biologic therapy once it becomes available and suggest that IL-1 blockade may provide a more sustainable long-term strategy for disease management.
The study underscores that IL-1 pathway inhibition is now a key component of recurrent pericarditis care, offering clinicians an evidence-based corticosteroid-sparing option. The shift documented in RESONANCE may guide treatment algorithms and enhance shared decision-making between physicians and patients seeking to avoid the complications of prolonged steroid therapy.
Reference:
Cremer PC et al. IL-1 Pathway Inhibition in Recurrent Pericarditis Management: Real-World Adoption of Corticosteroid Sparing in RESONANCE. JACC Adv. 2025;4(9):102050.
