Download INTERNATIONAL COLLABORATIVE SYSTEMATIC REVIEW OF

M. Lotrionte1, C. Moretti2, M. Imazio3, A. Abbate4, P. Di Pasquale5, M.
Raatikka6, A. Brucato7, I. Sheiban2, G. Biondi-Zoccai2
1Unità
di Scompenso Cardiaco e Riabilitazione, Complesso Integrato Columbus,
Roma, Italy; 2Divisione di Cardiologia 1, Ospedale San Giovanni Battista "Molinette",
Torino, Italy ([email protected]), 3Divisione di Cardiologia, Ospedale Maria
Vittoria, Torino, Italy 4VCU Pauley Heart Center, Richmond, VA, USA, 5Divisione di
Cardiologia, Ospedale G. F. Ingrassia, Palermo, Italy 6Department of Pediatrics,
Children Hospital, Helsinki, Finland 7Dipartimento di Medicina Interna, Ospedali
Riuniti, Bergamo, Italy
This work was supported by the Agenzia Italiana del Farmaco (AIFA),
with grant FARM7X58KC
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Acute pericarditis is common and can often
recur.
Despite widespread agreement on the
usefulness of non-steroidal antiinflammatory drugs (NSAIDs), uncertainty
persists on the role of other agents on top or
in lieu of NSAIDs.
We thus aimed to conduct a comprehensive
systematic review on pharmacologic
treatments for acute or recurrent pericarditis.
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Potentially relevant studies published up to
September 2009 were searched in BioMedCentral,
The Cochrane Collaboration Database of
Randomized Trials (CENTRAL), ClinicalTrials.gov,
EMBASE, Google Scholar, MEDLINE/PubMed, and
Scopus.
Studies were 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.
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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]).
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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.
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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 nonsteroidal 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.