The Use of CMR in Patients With Recurrent Pericarditis Initiating Rilonacept

Data published in the Journal of the American College of Cardiology demonstrate the use of cardiac magnetic resonance (CMR) imaging in the diagnosis, characterization, and monitoring of recurrent pericarditis in patients who initiated rilonacept (Arcalyst; Regeneron, Kiniksa).¹

Image credit: Sebastian Kaulitzki | stock.adobe.com

Recurrent pericarditis is a chronic autoinflammatory disease that is mediated by IL-1.¹ In a Pharmacy Times® interview with Jessica Farrell, PharmD, clinical pharmacist in the division of rheumatology at Albany Medical Center, she explained that pericarditis can occur on its own as a primary condition and can present as inflammation around the sac of the heart. It can sometimes be triggered by a virus. In patients with rheumatic disease, it can be a symptom of ongoing systemic inflammation. Common symptoms include pain and/or tightness in the chest that worsens when lying down; pain when coughing or breathing deeply; and fluid that can build up around the sac of the heart, which can be observed in imaging. For some patients, this pain may lessen or go away entirely if sitting up or leaning forward.²

In patients with RP, CMR may inform disease course, as T2-short tau inversion recovery (STIR) detects acute pericardial inflammation and edema and late gadolinium enhancement (LGE) assesses pericardial vascularity with high sensitivity.^3,4 Guidelines recommend the use of CMR to supplement clinical findings, and the current analysis of the RESONANCE dataset sought to understand whether CMR is utilized prior to rilonacept initiation in clinical practice.

Announced in March 2021, RESONANCE focused on furthering the understanding of the natural history of recurrent pericarditis, as well as documenting clinical, health-related quality of life, and economic burdens related to the condition. The goal of the registry is to help assist the medical community in the refinement and development of data-driven recommendations to clinically manage patients’ disease, therefore optimizing their outcomes. Additionally, it aims to generate data in support of rilonacept’s outcomes in a real-world setting. It is a voluntary patient database that enrolled both adult and pediatric patients.^5,6

“The RESONANCE registry is an excellent next step in research to enrich the understanding of recurrent pericarditis in partnership with clinicians, patients, and [the] industry,” Martin LeWinter, MD, FACC, FAHA, professor of medicine, cardiovascular unit at The University of Vermont, Larner College of Medicine, said in a 2021 news release that announced the registry’s initiation. “A significant unmet need remains for patients suffering from pericardial disease, and I am encouraged that the planned real-world data collection in this registry may help to better inform recommendations in the management and treatment of those with recurrent pericarditis.”⁶

The publication included 139 patients with a median age of 51 who initiated rilonacept during RESONANCE. Data were gathered from patients across 23 sites in the US. Approximately 48% (67/139) of participants had a CMR prior to the initiation of rilonacept. Of those, 66% (44/67) had CMR studies, which demonstrated evidence of pericardial inflammation. Nearly all patients (42/44) with evidence of pericardial inflammation on CMR also presented with clinical pericarditis signs and symptoms on prior treatment.¹

Over half of patients (52%, 72/139) did not have a CMR performed prior to rilonacept initiation. Those who had initiated rilonacept with evidence of pericardial inflammation by CMR (with/without clinical signs/symptoms; 44/139) had similar disease characteristics, prior to rilonacept initiation, versus those who had initiated rilonacept using clinical criteria alone (without evidence of inflammation by CMR; 95/139).

Among cardiologists and experts, CMR is utilized to diagnose, characterize, and monitor patients with recurrent pericarditis. These data show that the initiation of rilonacept was informed mostly by clinical criteria, according to the investigators, as nearly two-thirds of patients started rilonacept with only clinical signs/symptoms of pericarditis present. CMR has continued to demonstrate its capabilities in the detection of cardiovascular conditions.

REFERENCES

1. Weber B, Cremer P, Garshick MS, et al. Contemporary recurrent pericarditis management- real-world evidence of limited cardiac magnetic resonance imaging prior to initiating rilonacept. J Am Coll Cardiol. 2025;85(12, Supplement):1331. doi:10.1016/S0735-1097(25)01815-7

2. McGovern G. Pharmacists Educate and Bridge Communication Gaps for Patients With Pericarditis. Pharmacy Times. February 14, 2025. Accessed April 2, 2025. https://www.pharmacytimes.com/view/pharmacists-educate-and-bridge-communication-gaps-for-patients-with-pericarditis

3. Imazio M, Pivetta E, Restrepo SP, et al. Usefulness of cardiac magnetic resonance for recurrent pericarditis. Am J Cardiol. 2020;125(1):146-151. doi:10.1016/j.amjcard.2019.09.026

4. Imazio M, Klein AL, Brucato A, et al. Sustained pericarditis recurrence risk reduction with long-term rilonacept. J Am Heart Assoc. 2024;13(6):e032516. doi:10.1161/JAHA.123.032516

5. REgiStry Of the NAtural History of recurreNt periCarditis in pEdiatric and Adult Patients (RESONANCE). ClinicalTrials.gov identifier: NCT04687358. Updated October 22, 2024. Accessed April 2, 2025. https://clinicaltrials.gov/study/NCT04687358

6. Kiniksa. Kiniksa Launches Patient Registry (RESONANCE) for Recurrent Pericarditis. News release. March 2, 2021. Accessed April 2, 2025. https://investors.kiniksa.com/news-releases/news-release-details/kiniksa-launches-patient-registry-resonance-recurrent