Recent advances have shown impressive results by anti-interleukin 1 (IL-1) 
agents in refractory idiopathic recurrent pericarditis. PURPOSE OF REVIEW: We 
critically discuss the current state of the art of therapy of relapsing 
pericarditis, with a focus on new pharmacological approaches and on specific 
clinical settings such as pregnancy, pediatric patients, and secondary forms of 
relapsing pericarditis. RECENT FINDINGS: Antagonism of the IL-1 is highly 
effective in idiopathic recurrent pericarditis with autoinflammatory features. 
Currently, available anti-IL-1 agents are anakinra and canakinumab. Rilonacept 
is another IL-1 antagonist, currently studied in the phase-3 clinical trial 
RHAPSODY. Available data suggest similar efficacy and safety profiles of these 
three agents, although only anakinra has been tested in randomized clinical 
trials. These agents have slightly different pharmacological properties, being 
canakinumab a specific IL-1ß antagonist while anakinra and rilonacept are 
unselective IL-1α and IL-1ß blockers. To date, there is no evidence that 
specificity against IL-1ß affects safety and efficacy in patients with relapsing 
pericarditis, although it has been proposed that unspecific blockage might be 
useful in severe disease. Anakinra is the first anti-IL-1 agent with 
well-documented efficacy and safety in adult and pediatric patients with 
idiopathic relapsing pericarditis. Other anti-IL-1 agents are currently under 
study. Future research should clarify the optimal duration of therapy and 
tapering schedule of treatment with these agents. Moreover, biomarkers would be 
required to understand which patients will benefit from early administration of 
IL-1 blockers due to refractoriness to conventional therapy and which others 
will suffer from recurrences during the tapering of these agents. Lastly, future 
studies should focus on the subjects with the autoimmune or the 
pauci-inflammatory phenotype of idiopathic refractory pericarditis.