Emerging treatments
Antiviral therapy
Antiviral therapy is still being evaluated, and is rarely used in practice.[1] Some experts suggest antiviral treatment similar to that for myocarditis (e.g., intravenous immunoglobulin therapy in acute systemic enteroviral, cytomegalovirus, Epstein-Barr virus, and parvovirus B19 infection; oral valganciclovir in human herpesvirus-6 perimyocarditis; interferon alfa for enteroviral pericarditis).[1] However, antiviral therapy should only be considered after input from an infectious disease specialist.[1]
Intrapericardial fibrinolysis
This treatment is being investigated as an adjunct therapy for patients with infective pericarditis (i.e., tuberculous and purulent) where there is a high risk of constrictive pericarditis. Case reports and small trials have shown promising results; however, these results need to be replicated on a larger basis before this therapy is recommended.
Rilonacept
Rilonacept is a subcutaneously injected interleukin-1 alpha and beta cytokine trap approved by the US Food and Drug Administration for use in adults to treat recurrent pericarditis and to reduce risk of recurrence in adults and children aged 12 years and older. Among patients with recurrent pericarditis and systemic inflammation in the RHAPSODY trial, rilonacept led to rapid resolution of recurrent pericarditis episodes and to a significantly lower risk of pericarditis recurrence compared with placebo.[78] It is not currently approved in Europe for this indication, but has been granted orphan drug designation for idiopathic pericarditis.
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