Risk Factors Associated with Recurrence and Corticosteroid-Associated Adverse Events in Patients with Recurrent Pericarditis


Schwier NC1, Luis SA2, Hu X3, Athavale A4, Skaar J5, Magestro M3, Lim-Watson M3
1University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA, 2Mayo Clinic, Rochester, MN, USA, 3Kiniksa Pharmaceuticals, Lexington, MA, USA, 4Trinity Life Sciences, Waltham, MA, USA, 5Trinity Life Sciences, New York, NY, USA

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.

Conference/Value in Health Info

2021-05, ISPOR 2021, Montreal, Canada

Value in Health, Volume 24, Issue 5, S1 (May 2021)




Epidemiology & Public Health, Methodological & Statistical Research

Topic Subcategory

Artificial Intelligence, Machine Learning, Predictive Analytics


Cardiovascular Disorders

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