Abstract 8761: An International Collaborative Meta-Analysis on Pharmacologic Therapy of Acute Pericarditis
Background: Acute pericarditis is common, yet uncertainty persists on its treatment. We thus aimed to conduct a comprehensive systematic review on pharmacologic treatments for acute or recurrent pericarditis.
Methods: Controlled clinical studies were searched in several databases and included provided they focused on pharmacologic agents for acute pericarditis or its recurrences. Random-effect odds ratios (OR) were computed for long-term treatment failure, pericarditis recurrence, rehospitalization, and adverse drug effects.
Results: From 2078 citations, 7 studies were finally included (451 patients), but only 3 were randomized trials. Treatment comparisons were: colchicine vs. standard therapy (3 studies-265 patients), steroids vs. standard therapy (2 studies-31 patients), low-dose vs. high-dose steroids (1 study-100 patients), and statins vs. standard therapy (1 study-55 patients). Colchicine was associated with a reduced risk of treatment failure (OR=0.23 [0.11–0.49]), and recurrent pericarditis (OR=0.39 [0.20–0.77]), but with a trend toward more adverse effects (OR=5.27 [0.86–32.16]). Overall, steroids were associated with a trend toward increased risk of recurrent pericarditis (OR=7.50 [0.62–90.65]). Conversely, low-dose steroids proved superior to high-dose steroids for treatment failure or recurrent pericarditis (OR=0.29 [0.13–0.66]), rehospitalizations (OR=0.19 [0.06–0.63]), and adverse effects (OR=0.07 [0.01–0.54]). Data on statins were inconclusive.
Conclusions: Clinical evidence informing decision-making for the management of acute pericarditis and its recurrences is still limited to few, small, and/or low-quality clinical studies. Notwithstanding such major caveats, available studies routinely employing non-steroidal anti-inflammatory agents in both experimental and control groups suggest a beneficial risk-benefit profile for colchicine and a detrimental one for steroids, especially when used at high dosages.
- © 2010 by American Heart Association, Inc.