RESEARCH - Does TNF-alpha inhibition promote or prevent heart failure in patients with RA?

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Arthritis Rheum. 2008 Feb 29;58(3):667-677 [Epub ahead of print]

Does tumor necrosis factor alpha inhibition promote or prevent heart

failure in patients with rheumatoid arthritis?

Listing J, Strangfeld A, Kekow J, Schneider M, Kapelle A, Wassenberg S, Zink A.

German Rheumatism Research Centre, Berlin, Germany.

OBJECTIVE: To determine the hazard risk of developing or worsening

heart failure in rheumatoid arthritis (RA) patients treated with tumor

necrosis factor alpha (TNFalpha) inhibitors. METHODS: RA patients ages

18-75 years who started treatment with infliximab, etanercept, or

adalimumab (n = 2,757), or conventional disease-modifying

antirheumatic drugs (controls; n = 1,491) at the time of enrollment in

a German biologics register were studied. proportional hazards

models were applied to investigate the influence of disease-related

and treatment-specific risk factors on the incidence or worsening of

heart failure. RESULTS: The 3-year incidence rates of heart failure in

patients with and patients without cardiovascular disease at the start

of treatment were 2.2% and 0.4%, respectively. After adjustment for

traditional cardiovascular risk factors, an increased risk of

developing heart failure was found in patients who had a higher

28-joint Disease Activity Score at followup (hazard ratio

---

1.47

[95% confidence interval 1.07-2.02], P = 0.019). A residual

nonsignificant risk related to treatment with TNFalpha inhibitors

remained (adjusted HR 1.66 [95% confidence interval 0.67-4.1], P =

0.28). This residual risk was balanced by the efficacy of the anti-TNF

treatment. When only baseline characteristics were taken into account,

the HR related to TNFalpha inhibitor treatment decreased to 0.70 (95%

confidence interval 0.27-1.84).

CONCLUSION: The findings of this study indicate that TNFalpha

inhibitor treatment that effectively reduces the inflammatory activity

of RA is more likely to be beneficial than harmful with regard to the

risk of heart failure, especially if there is no concomitant therapy

with glucocorticoids or cyclooxygenase 2 inhibitors. Furthermore, the

data suggest that TNFalpha inhibition does not increase the risk of

worsening of prevalent heart failure.

PMID: 18311816 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/18311816

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