Advancing Pericarditis Care: The Evolving Role of IL-1 Inhibition and Pharmacist-Cardiologist Collaboration

In an interview with Pharmacy Times®, Allan L. Klein, MD, FRCP (C), FACC, FAHA, FASE, FESC, director at the Pericardial Disease Center and professor of medicine, and Sean Krohn, PharmD, CSP, MSCS, lead clinical pharmacist, specialty pharmacy, discussed the promising future of pericarditis treatment, highlighting the role of IL-1 inhibitors, novel imaging techniques, and ongoing clinical trials targeting the inflammasome. Klein emphasized the need for cardiologists to become more familiar with these therapies and described how improved diagnostics like T1 mapping and new long-acting monoclonal antibodies could enhance care. He also underscored the critical role of specialty pharmacists in streamlining access to these complex therapies and supporting long-term disease management. Krohn encouraged pharmacists to pursue continuing education and certification to better serve patients as this field continues to grow.

Pharmacy Times: Looking ahead, what are some of the evolving considerations or research areas in the treatment of pericarditis, particularly concerning the role of IL-1 inhibition and the potential for enhanced collaboration between cardiologists and pharmacists?

Allan L. Klein: I think the future is very bright in this field, involving both cardiologists and pharmacists.

First of all, there’s a learning curve for cardiologists. Most cardiologists are not that familiar with IL-1 blockers, so that’s been a big step up. Often, they think perhaps they should refer to a rheumatologist rather than a cardiologist. But for example, colchicine is getting into the domain of cardiologists themselves, as are IL-1 blockers.

Looking ahead, I think the future will bring improved diagnostic therapies. For example, MRIs can light up areas of inflammation, but often you have to give gadolinium, which is a contrast agent, to “light up” the inflamed pericardium. Perhaps in the future you won’t need gadolinium, and instead we’ll use what we call T1 mapping—just looking at and characterizing the tissue and the inflammation itself.

On the therapeutic side, rilonacept is a very good agent—and FDA-approved. Another agent is anakinra, which is not FDA-approved in the US, but trials in Europe (such as the AIRTRIP trial) have shown it to be very effective. There’s another IL-1 agent called gevokizumab from Russia, which seems quite similar to rilonacept, but it’s not approved in the U.S.

Any drugs that affect the inflammasome—part of the autoinflammatory cycle that pumps out IL-1 beta—are fair game for pericarditis treatment. There are some clinical trials listed on clinicaltrials.gov, including an oral inflammasome inhibitor from a company called VentYX, which is conducting a dose-response phase 2 trial.

I also mentioned the MAVERIC trial, which is testing a CBD agent that affects the inflammasome, lowers chest pain scores and CRP, and helps patients who have trouble discontinuing IL-1 blockers. In addition, Kiniksa, which makes rilonacept, has developed another agent: a once-monthly monoclonal antibody to IL-1 alpha and beta, now being tested in national and international clinical trials at about 60 sites. This drug is long-acting, comes in a liquid formulation, and has a long half-life.

So I think we’ll see many more clinical trials for drugs that target the inflammasome—and tremendous collaboration between pharmacists and cardiologists.

One thing I’d like to mention: before our specialty pharmacy got involved, it was very difficult to treat these patients, because all the prior authorizations went through the office. You basically had secretaries or admins trying to manage this complex field with these specialty drugs. Once the specialty pharmacy got involved, things ran much more smoothly. So I’m very grateful to have people like Sean and others in specialty pharmacy involved in these therapies.

This is a chronic disease—not a quick fix. It’s not like giving a short course of prednisone and calling it a day. These are three-to-five-year or longer chronic diseases. So there’s a lot of good collaboration with pharmacy now and in the future.

Pharmacy Times: What advice would you offer to pharmacists who are looking to expand their knowledge and involvement in the management of patients with pericarditis and novel therapies like rilonacept?

Sean Krohn: Continuing education is important. Know your resources and certifications. Don’t be afraid to further your education by obtaining a certification—there are many out there.

Often, employers may reimburse you for training or testing fees. Some examples include Certified Specialty Pharmacist (CSP), Board Certified Ambulatory Care Pharmacist (BCACP), and others.

Pharmacy Times: Is there anything you would like to add?

Klein: I’d just say there’s been an explosion of publications in the field. You mentioned education for pharmacists and cardiologists—and we’ve had the opportunity to work on the clinical trials and write many review articles now in key cardiology journals like JAMA Cardiology, JACC, and JACC: Advances, covering the state of the art with IL-1 blockers such as rilonacept and new imaging modalities.

So it’s a good field for pharmacists to get involved in—it’s growing. Cardiologists don’t know too much about the pharmacokinetics of these new drugs, and perhaps in the future there will be other biomarkers, aside from CRP or sedimentation rate, to follow.

So—stay tuned for developments in that area.