Human intravenous immunoglobulins for recurrent pericarditis: a multicentre cohort study

Aims: Based on limited data, intravenous immunoglobulins (IVIG) have been proposed as possible last therapeutic option for recurrent pericarditis (RP). The aim of this multicentre registry was to evaluate the efficacy and safety of IVIG in these patients after failure of other medical therapies. Methods: This multicentre cohort study enrolled consecutive patients with RP treated with IVIG. The primary outcome was the pericarditis recurrence rate after treatment with IVIG. Results: A total of 43 patients (median age 41.7±14.4 years, 65.1% women) were included. The median duration of disease was 39 months (19-70) and the mean recurrences before IVIG was 5 (4-6). Most patients had elevated C-reactive protein (76.7%), pericardial effusion (72.1%) and fever (69.8%). IVIG were administered at a dose of 400-500 mg/kg/day for 5 consecutive days with repeated cycles, if needed. At discharge 40 (93%) patients had achieved clinical remission with IVIG. After a mean follow-up of 73 (20-84) months the number of recurrences and of emergency department admissions/year were reduced respectively from 1.80 to 0.46 and 0.79 to 0.16 events/year (p<0.001). The need for corticosteroid and anakinra use was also reduced significantly by IVIG (respectively from 72.1% to 19.4%; P < 0.001 and 60.5% to 23.3%; P < 0.02). No difference in baseline characteristics was found between the patients who experienced a recurrence after the IVIG treatment and those who did not. No serious adverse events occurred, only one patient discontinued IVIG due to onset of moderate neutropenia, reversible within a few days. Conclusion: In patients with RP refractory to the conventional therapy, IVIG were efficacious and safe in reducing further recurrences after failure of other conventional medical therapies.