Chronische perikarditis welche therapeutische Möglichkeit

Therapeutic options for managing chronic pericarditis primarily focus on controlling inflammation, preventing recurrences, and minimizing corticosteroid dependence.

The foundational treatment includes high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin to reduce pericardial inflammation and pain, typically combined with colchicine, which inhibits neutrophil activity and assembly of the NLRP3 inflammasome. Colchicine effectively reduces recurrence rates and should be continued for at least six months in recurrent or chronic cases Alqahtani et al. 2026 Alqahtani et al. 2026Michaud et al. 2026.

Corticosteroids are reserved as a second-line therapy for patients who are refractory to NSAIDs and colchicine or have specific indications such as autoimmune or uremic pericarditis Alqahtani et al. 2026 Michaud et al. 2026. However, corticosteroid use requires caution due to associations with higher recurrence rates, prolonged disease course, and steroid dependence; slow tapering over months is recommended to minimize relapse Alqahtani et al. 2026 Alqahtani et al. 2026Michaud et al. 2026.

For patients with steroid-dependent, colchicine-resistant, or refractory chronic pericarditis, targeted immunomodulatory therapies that inhibit interleukin-1 (IL-1) have transformed management. Anakinra, a recombinant IL-1 receptor antagonist given subcutaneously daily, has demonstrated dramatic reductions in recurrences and allowed successful steroid withdrawal in clinical trials and real-world use Alqahtani et al. 2026 Alqahtani et al. 2026Imazio et al. 2025. Rilonacept, an IL-1α/β soluble receptor trap administered weekly subcutaneously, is FDA-approved specifically for recurrent pericarditis and has shown near elimination of recurrences during treatment Alqahtani et al. 2026 Michaud et al. 2026Imazio et al. 2025.

Other IL-1 targeted agents under investigation include canakinumab, goflikicept, and KPL-387, which offer additional options for blocking IL-1 pathways and may provide more convenient dosing schedules or improved tolerability Alqahtani et al. 2026 Alqahtani et al. 2026Imazio et al. 2025.

Emerging oral therapies targeting the upstream NLRP3 inflammasome, such as the small molecule VTX2735 and cannabidiol derivative CardiolRx, are in clinical trials and promise less immunosuppressive, steroid-sparing alternatives that may further improve chronic pericarditis management Alqahtani et al. 2026 Alqahtani et al. 2026Imazio et al. 2025.

In refractory cases unresponsive to medical therapy, surgical options like pericardiectomy may be considered, particularly for patients with constrictive or incessant pericarditis, although surgery is invasive and reserved for carefully selected patients Alqahtani et al. 2026 Michaud et al. 2026Adler et al. 2015.

Management of chronic pericarditis should be individualized, guided by biomarkers such as C-reactive protein (CRP), advanced imaging including cardiac magnetic resonance for inflammation assessment, and clinical phenotype Alqahtani et al. 2026 Alqahtani et al. 2026Michaud et al. 2026. This approach helps optimize treatment duration, tapering regimens, and early identification of patients needing escalation to targeted therapies.

Overall, current guidelines recommend initial therapy with NSAIDs and colchicine, limited and cautious use of corticosteroids, and incorporation of IL-1 blockers for chronic, recurrent, or steroid-dependent cases, while research continues on novel immunomodulatory agents to improve outcomes and reduce the burden of chronic pericarditis Alqahtani et al. 2026 Imazio et al. 2025Michaud et al. 2026.