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Role of immunosuppressive therapy in the management refractory postprocedural pericarditis
Author(s) -
Narasimhan Bharat,
Turagam Mohit K.,
Garg Jalaj,
Della Rocca Domenico G.,
Gopinathannair Rakesh,
Biase Luigi Di,
Romero Jorge,
Mohanty Sanghamitra,
Natale Andrea,
Lakkireddy Dhanunjaya
Publication year - 2021
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.15069
Subject(s) - medicine , refractory (planetary science) , regimen , prednisone , adverse effect , surgery , methotrexate , retrospective cohort study , pharmacotherapy , population , environmental health , astrobiology , physics
Objective To assess the safety and efficacy of a novel immunosuppressive regimen—combination Methotrexate/Prednisone (cMtx/P)—in the management of severe refractory rPPP. Methods In this multicenter, nonrandomized, retrospective, observational study, 408 consecutive patients diagnosed with persistent rPPP between 2017 and 19 were included. Patients with refractory symptoms despite 3 months of conventional therapy were initiated on a 4‐week regimen of oral steroids. Persistence of symptoms at this point, that is, rPPP ( n = 25; catheter based = 18, open surgical = 7) prompted therapy with Methotrexate (7.5–15 mg weekly) with folate supplementation along with low dose prednisone (5 mg PO) for a further 3 months. Patients were followed for a total of 11.3 ± 1.8 months. Results Treatment refractory rPPP occurred in 6.1% of the study population prompting immunosuppressive therapy with cMtx/P. All patients demonstrated complete symptom resolution following 3 months of treatment with an 85% decline in clinically significant pericardial effusions. One patient developed recurrent pericarditis during the 11‐month follow‐up. Therapy was well tolerated with no significant drug related adverse effects. Conclusion cMtx/P therapy is a safe and effective adjunct in the management of rPPP refractory to standard therapy.