The treatment of pericarditis — especially the recurrent form that has long frustrated patients and clinicians — has been transformed by interleukin-1 blockade.
First-line therapy
Colchicine combined with NSAIDs remains first-line for acute pericarditis, with colchicine roughly halving the recurrence rate. Corticosteroids are generally avoided as first-line because they are associated with more recurrences.
Interleukin-1 blockade for recurrent pericarditis
For recurrent pericarditis — particularly corticosteroid-dependent or colchicine-resistant disease — IL-1 blockers have become key. The pivotal RHAPSODY trial showed that rilonacept, an IL-1α/IL-1β cytokine trap, produced rapid symptom resolution and dramatically reduced recurrence (about 7% versus 74% with placebo during the randomized-withdrawal period), leading to its approval for recurrent pericarditis. Anakinra, an IL-1 receptor antagonist, is also effective (as shown in the AIRTRIP trial) and is often used off-label. These agents target the autoinflammatory IL-1 pathway that drives the recurrent, colchicine-resistant phenotype, and newer IL-1 agents are in trials.
Further reading: RHAPSODY rilonacept (Klein et al., NEJM 2021); diagnosis and treatment of pericarditis review (Cremer et al., JAMA 2024); anti-IL-1 agents for pericarditis (Imazio et al., European Heart Journal 2022).