Corticosteroids for Recurrent Pericarditis: High Versus Low Doses: A Nonrandomized Observation.
Imazio, Massimo MD; Brucato, Antonio MD; Cumetti, Davide MD; Brambilla, Giovanni MD; Demichelis, Brunella MD; Ferro, Silvia MD; Maestroni, Silvia MD; Cecchi, Enrico MD; Belli, Riccardo MD; Palmieri, Giancarlo MD; Trinchero, Rita MD
118(6):667-671, August 5, 2008.
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Background-: Corticosteroid use is widespread in recurrent pericarditis, even if rarely indicated, and high doses (eg, prednisone 1.0 to 1.5 mg [middle dot] kg-1 [middle dot] d-1) are generally recommended, although only weak evidence supports their use with possible severe side effects. The aim of this work was to compare side effects, recurrences and other complications, and hospitalizations of a low- versus high-dose regimen of prednisone for recurrent pericarditis.
Methods and Results-: A retrospective review of all cases of recurrent pericarditis treated with corticosteroids according to different regimens from January 1996 to June 2004 was performed in 2 Italian referral centers. One hundred patients with recurrent pericarditis (mean age, 50.1 /-15.8 years; 57 females) were included in the study; 49 patients (mean age, 47.5 /-16.0; 25 females) were treated with low doses of prednisone (0.2 to 0.5 mg [middle dot] kg-1 [middle dot] d-1), and 51 patients (mean age, 52.6 /-15.3; 32 females) were treated with prednisone 1.0 mg [middle dot] kg-1 [middle dot] d-1. Baseline demographic and clinical characteristics were well balanced across the groups. Each initial dose was maintained for 4 weeks and then slowly tapered. After adjustment for potential confounders (age, female gender, nonidiopathic origin), only high doses of prednisone were associated with severe side effects, recurrences, and hospitalizations (hazard ratio, 3.61; 95% confidence interval, 1.96 to 6.63; P<0.001).
Conclusions-: Use of higher doses of prednisone (1.0 mg [middle dot] kg-1 [middle dot] d-1) for recurrent pericarditis is associated with more side effects, recurrences, and hospitalizations. Lower doses of prednisone should be considered when corticosteroids are needed to treat pericarditis.
(C) 2008 American Heart Association, Inc.