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(Circulation. 2008;118:667-671.)
© 2008 American Heart Association, Inc.

Pericardial Disease

Corticosteroids for Recurrent Pericarditis

High Versus Low Doses: A Nonrandomized Observation

Massimo Imazio, MD; Antonio Brucato, MD; Davide Cumetti, MD; Giovanni Brambilla, MD; Brunella Demichelis, MD; Silvia Ferro, MD; Silvia Maestroni, MD; Enrico Cecchi, MD; Riccardo Belli, MD; Giancarlo Palmieri, MD; Rita Trinchero, MD

From the Cardiology Department, Ospedale Maria Vittoria, Torino (M.I., B.D., S.F., E.C., R.B., R.T.); Department of Internal Medicine, Ospedali Riuniti, Bergamo (A.B., D.C., S.M.); and Department of Emergency Medicine, and Internal Medicine, Ospedale Niguarda, Milan (G.B., G.P.), Italy.

Correspondence to Massimo Imazio, MD, FESC, Cardiology Department, Maria Vittoria Hospital, Via Cibrario 72, 10141 Torino, Italy. E-mail massimo_imazio{at}yahoo.it

Received December 18, 2007; accepted May 30, 2008.

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.

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