Document Detail


International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences.
MedLine Citation:
PMID:  20934560     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Acute pericarditis is common, yet uncertainty persists on its treatment. We thus aimed to conduct a comprehensive systematic review on pharmacologic treatments for acute or recurrent pericarditis. METHODS: Controlled clinical studies were searched in several databases and were included provided they focused on pharmacologic agents for acute pericarditis or its recurrences. Random-effect odds ratios (ORs) were computed for long-term treatment failure, pericarditis recurrence, rehospitalization, and adverse drug effects. RESULTS: From 2,078 citations, 7 studies were finally included (451 patients); but only 3 were randomized trials. Treatment comparisons were as follows: colchicine versus standard therapy (3 studies, 265 patients), steroids versus standard therapy (2 studies, 31 patients), low-dose versus high-dose steroids (1 study, 100 patients), and statins versus standard therapy (1 study, 55 patients). Colchicine was associated with a reduced risk of treatment failure (OR = 0.23 [0.11-0.49]) and recurrent pericarditis (OR = 0.39 [0.20-0.77]), but with a trend toward more adverse effects (OR = 5.27 [0.86-32.16]). Overall, steroids were associated with a trend toward increased risk of recurrent pericarditis (OR = 7.50 [0.62-90.65]). Conversely, low-dose steroids proved superior to high-dose steroids for treatment failure or recurrent pericarditis (OR = 0.29 [0.13-0.66]), rehospitalizations (OR = 0.19 [0.06-0.63]), and adverse effects (OR = 0.07 [0.01-0.54]). Data on statins were inconclusive. CONCLUSIONS: Clinical evidence informing decision-making for the management of acute pericarditis and its recurrences is still limited to few, small, and/or low-quality clinical studies. Notwithstanding such major caveats, available studies routinely using nonsteroidal anti-inflammatory agents in both experimental and control groups suggest a beneficial risk-benefit profile for colchicine and a detrimental one for steroids, especially when used at high dosages.
Authors:
Marzia Lotrionte; Giuseppe Biondi-Zoccai; Massimo Imazio; Davide Castagno; Claudio Moretti; Antonio Abbate; Pierfrancesco Agostoni; Antonio L Brucato; Pietro Di Pasquale; Marja Raatikka; Giuseppe Sangiorgi; Antonio Laudito; Imad Sheiban; Fiorenzo Gaita
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  American heart journal     Volume:  160     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-11     Completed Date:  2010-10-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  662-70     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Mosby, Inc. All rights reserved.
Affiliation:
Unit of Heart Failure and Cardiac Rehabilitation, Catholic University, Rome, Italy.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Anti-Inflammatory Agents / therapeutic use*
Controlled Clinical Trials as Topic / methods*
Humans
International Cooperation*
Pericarditis / drug therapy*
Recurrence / prevention & control
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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