By Jane Smith | NEW YORK – 2025/06/07 10:19:32

In a recent interview, Allan L. Klein, MD, director at Pericardial Disease Center and professor of medicine, along with Sean Krohn, PharmD, lead clinical pharmacist, discussed the use of rilonacept in treating recurrent pericarditis. The experts detailed how rilonacept works by blocking IL-1 inflammatory pathways, offering a new approach for patients who don’t respond well to traditional treatments like steroids. Thay also explained the inflammatory process in conditions like atrial fibrillation ablation and highlighted key aspects of rilonacept administration.

How Rilonacept Targets Inflammation

Dr. Klein explained the mechanism of action of rilonacept, particularly in the context of complications following procedures like atrial fibrillation ablation. He described a scenario where blood enters the pericardial space, triggering an inflammatory response. “Macrophages get attracted to the surface; IL-alpha is released as macrophages are attracted,” said Dr. Klein.”The IL-alpha attaches to the macrophage, and inside the cell there’s what you call an inflammasome.” This inflammasome activates IL-beta, leading to capillary leak and a cascade of inflammation. Rilonacept works by trapping IL-alpha and beta, effectively blocking this inflammatory cycle.

The IL-1 blockers, in particular, rilonacept traps IL-alpha and beta… That’s the mechanism, so if you had an IL blocker that targets this type of mechanism, you would have a good thing for recurrence and block the whole cycle.

Patient Selection and Treatment Progression

Dr. Klein also outlined the typical progression of pericarditis treatment. Acute pericarditis, he noted, lasts for 4 to 6 weeks, while recurrent pericarditis returns after tapering medication, usually within 3 months. Traditionally, treatment starts with NSAIDs and exercise restriction, followed by low-dose steroids. “Then the third line would be the IL-1 blockers or methotrexate,” Dr. Klein stated. “The fourth line would be the pericardiectomy.” though, he emphasized a shift towards using biologics like rilonacept earlier in the treatment process, especially for patients who are steroid-resistant or dependent. He added, “Currently there’s a paradigm shift, so you basically go from level 1, and you bypass steroids and go to the biologics.”

according to Dr.Klein, ideal candidates for rilonacept are those failing standard treatments and experiencing recurring flare-ups. He gave the example of a young patient in their 30s who cannot tolerate colchicine and faces notable side effects from steroids. “You would have trouble weaning off the steroids over many months, so that’s why biologics might potentially be a better thing to go with,” he explained.

Rilonacept Administration: Key Considerations

sean Krohn, PharmD, highlighted the critical aspects of rilonacept administration. “I would say the most critical aspects would be storage of the medication, as well as the importance of injection training by a health care professional prior to patients starting the injection on their own,” said Krahn. Rilonacept requires refrigeration and is shipped with ice packs. Krohn emphasized the importance of patient education and coordination, stating, “We never automatically shipped the medication to the patient’s home without them being aware.” He also noted that specialty pharmacies should offer 24/7 access to pharmacists for any questions or concerns. Given that rilonacept requires reconstitution, proper injection training is essential to ensure patient safety and adherence.