Emerging therapies for pericarditis: from anti-IL-1 agents to novel therapeutic options

INTRODUCTION: Although often self-limited, acute pericarditis recurs in up to 30% of patients. Recurrent pericarditis (RP) causes substantial morbidity (pain, fatigue, and impaired quality of life) and can lead to constriction. Traditional treatments have important limitations, including corticosteroid dependence, recurrent flares, and treatment-related adverse effects. Emerging targeted immunomodulators are therefore under active investigation. AREAS COVERED: This review summarizes the burden of pericarditis across etiologies, current therapies, and the global market for pericarditis treatment. We then focus on novel agents in development with an emphasis on phase II/III studies. The pathobiology of pericardial inflammation (notably interleukin (IL)-1 and inflammasome pathways) is discussed as the rationale for targeted drugs. We review key trials of IL-1 inhibitors, NLRP3 inhibitors (VTX2735), and other innovations (e.g. cannabidiol-based CardiolRx). Potential obstacles to development are examined. EXPERT OPINION: Randomized-withdrawal trials support a marked reduction in recurrences with IL-1 blockade in selected patients with inflammatory, colchicine-resistant and corticosteroid-dependent RP. However, open-label enrichment, small samples, short follow-up, uncertain durability after withdrawal, cost, and limited evidence outside idiopathic or post-cardiac injury disease restrict generalizability. New pipeline agents hold promise for broader use, however remain investigational until controlled trials establish their efficacy and long-term safety.