title: Intravenous human immunoglobulins for refractory recurrent pericarditis: a systematic review of all published cases.
abstract: OBJECTIVE
  Refractory recurrent pericarditis is a major clinical challenge after colchicine failure, especially in corticosteroid-dependent patients. Human intravenous immunoglobulins (IVIGs) have been proposed as possible therapeutic options for these cases. The goal of this systematic review is to assess the efficacy and safety of IVIGs in this context.
  
  
  METHODS
  Studies reporting the use of IVIG for the treatment of recurrent pericarditis and published up to October 2014 were searched in several databases. All references found, upon initial assessment at title and abstract level for suitability, were consequently retrieved as full reports for further appraisal.
  
  
  RESULTS
  Among the 18 citations retrieved, 17 reports (4 case series and 13 single case reports, with an overall population of 30 patients) were included. The mean disease duration was 14 months and the mean number of recurrences before IVIG was 3. Approximately 47% of patients had idiopathic recurrent pericarditis, 10% had an infective cause, and the remainder a systemic inflammatory disease. Nineteen out of the 30 patients (63.3%) were on corticosteroids at IVIG commencement. IVIGs were generally administered at a dose of 400-500 mg/kg/day for 5 consecutive days with repeated cycles according to the clinical response. Complications were uncommon (headache in ~3%) and not life-threatening. After a mean follow-up of approximately 33th months, recurrences occurred in 26.6% of cases after the first IVIG cycle, and 22 of the 30 patients (73.3%) were recurrence-free. Five patients (16.6%) were on corticosteroids at the end of the follow-up.
  
  
  CONCLUSIONS
  IVIGs are rapidly acting, well tolerated, and efficacious steroid-sparing agents in refractory pericarditis.
authors.affiliation: aCardiology Department, Maria Vittoria Hospital and University of Torino, Torino, Italy b1st Department of Cardiology, University of Athens Medical School, Hippokration General Hospital, Athens, Greece cUniversity Division of Cardiology, Città della Salute e della Scienza, University of Torino, Torino, Italy *Massimo Imazio and George Lazaros contributed equally to the writing of this article.
authors.forename: Massimo
authors.initials: M
authors.lastname: Imazio
authors.forename: George
authors.initials: G
authors.lastname: Lazaros
authors.forename: Elisa
authors.initials: E
authors.lastname: Picardi
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Vasileiou
authors.forename: Mara
authors.initials: M
authors.lastname: Carraro
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tousoulis
authors.forename: Riccardo
authors.initials: R
authors.lastname: Belli
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D010493:Pericarditis / Q000188:drug therapy*; D012008:Recurrence
chemical_list: D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents