RESEARCH - TNF blockers linked to heart failure in elderly

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TNF Blockers Linked to Heart Failure in Elderly

NEW YORK (Reuters Health) Sept 15 - In elderly patients with

rheumatoid arthritis, treatment with tumor necrosis factor (TNF)-alpha

antagonists may increase their risk of new-onset heart failure, and

exacerbate pre-existing heart failure.

In a study reported in the American Heart Journal for August, anti-TNF

treatment appeared to quadruple the risk of mortality due to

established heart failure compared with methotrexate treatment.

Previous research among relatively young patients with rheumatoid

arthritis indicated that TNF blockers may reduce the risk of heart

failure, the investigators at Harvard Medical School note in their

paper. Other studies, however, demonstrated potential harm to patients

with symptomatic heart failure.

To clarify these issues, Dr. Soko Setoguchi and colleagues conducted a

cohort study using information from Medicare databases for 1994-2004.

The cohort included patients age 65 and older who had at least one

prescription for a TNF antagonist (etanercept or infliximab, n = 1002)

or methotrexate (n = 5593) following a diagnosis of rheumatoid

arthritis. Among those subjects, 1033 already had heart failure.

Compared to methotrexate treatment, TNF blocker therapy conferred an

adjusted hazard ratio for hospitalization for heart failure of 1.70,

regardless of heart failure history.

Among patients with pre-existing heart failure, the adjusted hazard

ratio for death among those using TNF antagonists was 4.2.

The Boston-based team estimates that, for elderly patients, the

number-needed-to-harm in terms of hospitalization for heart failure

from anti-TNF treatment is 19 for those with prior heart failure and

105 for those without heart failure when treatment is initiated. The

number-needed-to-harm for death could be as low as 5, among patients

with pre-existing heart failure.

" Our results do not rule out the hypothesis that blocking TNF-alpha

may reduce the risk of heart failure in younger patients with

rheumatoid arthritis, " Dr. Setoguchi and her associates note. They

suggest that there could be a differential effect of TNF-alpha in

patients with and without cardiovascular conditions.

They call for " larger and more detailed studies " to more clearly

define the risk-benefit ratio of TNF blockade among elderly patients

with rheumatoid arthritis.

Am Heart J 2008;156:336-341.

http://www.medscape.com/viewarticle/580505

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