Session Type: Poster Session A
Session Time: 8:30AM-10:30AM
Background/Purpose: The magnitude of pericardial delayed hyperenhancement (DHE) by cardiac magnetic resonance imaging (CMR) illustrates the severity of inflammation in pericarditis. We hypothesized that patients with more severe DHE at baseline may experience earlier recurrence of pericardial disease after interruption of pharmacotherapy that had led to clinical response.
Methods: RHAPSODY is a phase 3 randomized withdrawal (RW) trial of rilonacept, an Interleukin-1α and 1β trap, in patients with recurrent pericarditis (RP) presenting with acute symptoms despite standard of care. Following a run-in period of 12 weeks of rilonacept treatment, clinical responders on rilonacept monotherapy were randomized 1:1 to placebo or continued rilonacept in a double-blind RW period. CMR was collected at baseline prior to rilonacept initiation in 25/86 patients, of whom 14 were later randomized to placebo in the RW period. CMRs were graded (none, trace, mild, moderate, severe, or not measurable) by a central imaging laboratory. We analyzed the baseline CMR data in the context of time to recurrence after randomization.
Results: 25 patients had CMR at baseline: 8% trace, 28% mild, 20% moderate, and 44% severe DHE. In patients randomized to placebo with moderate or severe DHE at baseline, 71.4% experienced a recurrence, with a median time to recurrence of 4.2 weeks. In patients randomized to placebo with trace or mild DHE at baseline, 71.4% experienced a recurrence, but with a longer median time to recurrence of 10.7 weeks after randomization. In patients with CMR at baseline randomized to receive continued rilonacept, none experienced a recurrence during the RW period; 82% had moderate or severe DHE at baseline.
Conclusion: These data support the hypothesis that more severe pericardial DHE at baseline may be associated with shorter time to pericarditis recurrence after interruption of rilonacept therapy. There is growing evidence that the assessment of DHE in the broader context of the evaluation of patients with recurrent pericarditis could be a helpful adjunct for determining treatment duration in affected patients.
To cite this abstract in AMA style:Cremer P, Lin D, Wheeler A, Abbate A, Brucato A, Fang F, Insalaco A, LeWinter M, Lewis B, Luis S, Nicholls S, Petersen J, Klein A, Imazio M, Paolini J. Cardiac Magnetic Resonance Imaging for Guiding Decision-making on Treatment Duration: Data from RHAPSODY, a Phase 3 Clinical Trial of Rilonacept in Recurrent Pericarditis [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/cardiac-magnetic-resonance-imaging-for-guiding-decision-making-on-treatment-duration-data-from-rhapsody-a-phase-3-clinical-trial-of-rilonacept-in-recurrent-pericarditis/. Accessed January 27, 2023.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiac-magnetic-resonance-imaging-for-guiding-decision-making-on-treatment-duration-data-from-rhapsody-a-phase-3-clinical-trial-of-rilonacept-in-recurrent-pericarditis/