Comparative efficacy and safety of colchicine and interleukin-1 antagonists in recurrent pericarditis: a network meta-analysis.

Introduction: Despite advancement of therapeutic approaches to recurrent pericarditis, it poses notable challenges to its' management. As per the current guidelines, colchicine is the first line therapy, although, non-conventional treatments like interleukin-1 (IL-1) antagonists (rilonacept, anakinra, goflikicept) are progressively utilized for refractory cases.

Evidence Acquisition: A comprehensive electronic search identified relevant literature across multiple databases, focusing on recurrence rates and adverse effects associated with each treatment regimen.

Evidence Synthesis: Eleven studies (6 on colchicine, 5 on IL-1 antagonists) involving 1053 patients were included. Colchicine significantly reduced recurrence risk by 63% (OR 0.37, 95% CI 0.27-0.52). IL-1 antagonists demonstrated superior efficacy: anakinra reduced recurrence by 98% (OR 0.02, 95% CI 0.01-0.07), rilonacept by 98% (OR 0.02, 95% CI 0.01-0.07), and goflikicept by 99% (OR 0.01, 95% CI 0.00-0.05). Adverse effects were comparable between colchicine and IL-1 antagonists except for rilonacept, which showed a higher risk (OR 5.70, 95% CI 2.13-15.27).

Conclusions: IL-1 antagonists significantly reduce recurrent pericarditis episodes compared to colchicine, with anakinra, rilonacept, and goflikicept demonstrating high efficacy and acceptable safety profiles. These findings support their consideration as alternative therapies in colchicine-refractory cases of recurrent pericarditis. Further studies are warranted to refine treatment guidelines and optimize patient outcomes.