OBJECTIVES : Recurrent pericarditis (RP) occurs in up to 30% of acute pericarditis patients with some experiencing multiple recurrences and/or complications. Treating RP with corticosteroids can increase adverse events, risk of recurrence, and potentially healthcare resource utilization. This retrospective study examined risk factors for recurrence and corticosteroid-related adverse events (CS-AEs) among RP patients.

METHODS : RP patients (age ≥12 years) with ≥2 recurrences or 1 recurrence with a serious complication, were identified from the Inovalon Ability claims database (2013-2020). Recurrence was defined as a pericarditis episode occurring ≥28 days after an index “idiopathic” pericarditis episode. Multivariable models examined risk factors for recurrence or CS-AEs.

RESULTS : Amongst 3,899 RP patients, shorter time between the index episode and first recurrence [OR 1.05 (95% CI 1.03-1.07)], insufficient response to colchicine [OR 1.87 (95% CI 1.55-2.25)], insufficient response to NSAIDs or aspirin [OR 1.35 (95% CI 1.09-1.66)], hypercholesterolemia [OR 1.54 (95% CI 1.11-2.14)], and hypertension [OR 1.45 (95% CI 1.19-1.77)] were independently associated with increased risk of subsequent recurrence. Out of 1,728 RP patients, an increased rate of CS-AEs was observed among patients who received corticosteroids compared with those who did not (50% vs 36%, p<0.001; NNH 7), including: non-alcoholic steatohepatitis (5% vs 2%, p=0.003), hyperglycemia (8% vs 5%, p=0.04), and osteoporosis (3% vs 0%, p<0.0001). Multivariable modeling showed CS use [OR 1.75 (95% CI 1.30-2.36)] and duration [OR 1.11 (95% CI 1.04-1.19) per week of CS exposure] were independently associated with increased risk of CS-AEs. Increased age, multiple comorbidities, fluid and electrolyte disorders, depression, and immunodepressive conditions were each associated with an increased risk of CS-AEs.

CONCLUSIONS : Clinical characteristics and medical history are important considerations for RP treatment strategies to reduce the risk of CS-AEs and future recurrences. More targeted CS-sparing therapies are warranted in order to reduce pericardial inflammation while mitigating CS-AEs.