Corticosteroids for recurrent pericarditis: high versus low doses: a nonrandomized observation.
BACKGROUND
Corticosteroid use is widespread in recurrent pericarditis, even if rarely indicated, and high doses (eg, prednisone 1.0 to 1.5 mg . kg(-1) . 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.


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 . kg(-1) . d(-1)), and 51 patients (mean age, 52.6+/-15.3; 32 females) were treated with prednisone 1.0 mg . kg(-1) . 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 . kg(-1) . 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.
Imazio
Massimo
M
Cardiology Department, Maria Vittoria Hospital, Via Cibrario 72, 10141 Torino, Italy. massimo_imazio@yahoo.it
Brucato
Antonio
A
Cumetti
Davide
D
Brambilla
Giovanni
G
Demichelis
Brunella
B
Ferro
Silvia
S
Maestroni
Silvia
S
Cecchi
Enrico
E
Belli
Riccardo
R
Palmieri
Giancarlo
G
Trinchero
Rita
R
D000328:Adult; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010493:Pericarditis / Q000188:drug therapy*; D011241:Prednisone / Q000008:administration & dosage* / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome
D005938:Glucocorticoids; D011241:Prednisone