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The Use of CMR in Patients With Recurrent Pericarditis Initiating Rilonacept
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Key Takeaways
- CMR imaging is crucial for diagnosing and monitoring recurrent pericarditis, especially in complex cases.
- The RESONANCE registry aims to improve understanding and management of recurrent pericarditis and assess rilonacept's real-world effectiveness.
The registry data showed that cardiac magnetic resonance (CMR) was obtained in more clinically complex patients with recurrent pericarditis.
Data published in the Journal of the American College of Cardiology demonstrate the use of cardiac magnetic resonance (CMR) imaging in the diagnosis, characterization, and monitoring of recurrent pericarditis in patients who initiated rilonacept (Arcalyst; Regeneron, Kiniksa). Specifically, CMR was used more often in patients who had clinically complex recurrent pericarditis.1
Image credit: Sebastian Kaulitzki | stock.adobe.com
Recurrent pericarditis is a chronic autoinflammatory disease that is mediated by IL-1.1 In a Pharmacy Times® interview with Jessica Farrell, PharmD, clinical pharmacist in the division of rheumatology at Albany Medical Center, she explained that pericarditis can occur on its own as a primary condition and can present as inflammation around the sac of the heart. It can sometimes be triggered by a virus. In patients with rheumatic disease, it can be a symptom of ongoing systemic inflammation. Common symptoms include pain and/or tightness in the chest that worsens when lying down; pain when coughing or breathing deeply; and fluid that can build up around the sac of the heart, which can be observed in imaging. For some patients, this pain may lessen or go away entirely if sitting up or leaning forward.2
Because imaging may present signs of recurrent pericarditis, investigators of the RESONANCE (NCT04687358)3, a US observational registry, assessed all CMR use in patients with recurrent pericarditis. Additionally, imaging was conducted prior to patients’ initiation of rilonacept, an IL-1α and IL-1β cytokine trap that is the only FDA-approved treatment for the disease.1
Announced in March 2021, the RESONANCE registry focused on furthering the understanding of the natural history of recurrent pericarditis, as well as documenting clinical, health-related quality of life, and economic burdens related to the condition. The goal of the registry is to help assist the medical community in the refinement and development of data-driven recommendations to clinically manage patients’ disease, therefore optimizing their outcomes. Additionally, it aims to generate data in support of rilonacept’s outcomes in a real-world setting. It is a voluntary patient database that enrolled both adult and pediatric patients.3,4
“The RESONANCE registry is an excellent next step in research to enrich the understanding of recurrent pericarditis in partnership with clinicians, patients, and [the] industry,” Martin LeWinter, MD, FACC, FAHA, professor of medicine, cardiovascular unit at The University of Vermont, Larner College of Medicine, said in a news release that announced the registry’s initiation. “A significant unmet need remains for patients suffering from pericardial disease, and I am encouraged that the planned real-world data collection in this registry may help to better inform recommendations in the management and treatment of those with recurrent pericarditis.”4
Among the 103 patients (median age: 49.7 years) included in the registry, approximately 56% were female. Data were gathered from patients at 22 sites (19 academic medical centers [AMCs], n = 97; 3 non-AMC sites, n = 6). The findings showed that the median disease duration was about 1.0 year (range: 0.4, 2.9) with about 1.5 (range: 1.0, 2.0) prior recurrences. Approximately 45% of patients (n = 46) had CMR before the initiation of rilonacept, of which 98% (n = 45) were managed at AMCs, and 59% (n = 27) presented pericardial inflammation.1
Further, about 54% of patients who initiated rilonacept (n = 52) at AMCs and 83% (n = 5) at non-AMCs did not have a CMR. Those who have CMR had a similar disease duration (1.0 year [range: 0.5, 2.9]); however, there were more prior recurrences (2.0 [range: 1.0, 3.0]) and more prior steroid use (52%; 0.9 [range: 0.4, 2.9]) than those who did not have a CMR (32%; 1 [range: 1.0, 2.0]).1
Among cardiologists and experts, CMR is utilized to diagnose, characterize, and monitor patients with recurrent pericarditis. These data show that the initiation was informed mostly by clinical criteria, according to the investigators, and that CMR was obtained more in clinically complex patients. CMR has continued to demonstrate its capabilities in the detection of cardiovascular conditions.
