RESEARCH - TNF blockade reduces circulating NT-proBNP levels in RA patients with active disease

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Ann Rheum Dis. Published Online First: 23 November 2009.

doi:10.1136/ard.2009.119412

TNF blockade therapy reduces circulating NT-proBNP levels in RA

patients with active disease: results from prospective cohort study

Mike J L s1,*, Welsh2, Iain B McInnes2, Gerrit Jan Wolbink3,

Ben A C Dijkmans1, T Nurmohamed1, Naveed Sattar2

1 VU University Medical Center, Netherlands;

2 Glasgow University, United Kingdom;

3 Jan van Breemen Instituut, Netherlands

ABSTRACT

Background: Patients with rheumatoid arthritis (RA) are at increased

risk for heart failure (HF) and vascular events. Small elevations in

circulating N-terminal pro-brain natriuretic peptide (NT-proBNP) are

associated with increased cardiovascular event risk, and high levels

signal left ventricular dysfunction. Data on the effects of a TNF

blocking agents on circulating NT-proBNP levels in active RA patients

are lacking, but may be informative.

Methods: 171 consecutive RA patients (disease activity score-28 above

3.2) without congestive HF (NYHA class III or IV) were scheduled to

receive adalimumab once every 2 weeks. Serum NT-proBNP concentrations

were measured simultaneously on stored baseline and 16 week samples.

Paired sample t-tests were used to observe differences in biomarkers

before and after adalimumab administration. Pearson’s test evaluated

biomarker correlations with changes in circulating log NT-proBNP

levels, and multivariable linear regression analyses of correlates

were performed (forward selection procedure).

Results: Circulating levels of NT-proBNP decreased significantly after

16 weeks of adalimumab administration: median NT-proBNP 83.0 pg/ml

versus 69.5 pg/ml, p = 0.004. Changes in NT-proBNP were associated

with changes in pulse pressure (r = 0.18, p = 0.02), systolic blood

pressure (r = 0.16, p = 0.04), and ESR (r = 0.18, p = 0.02). On

multivariable analysis, changes in pulse pressure and ESR remained

independently associated with changes in circulating NT-proBNP.

Discussion: Our novel observations demonstrate that blocking TNF in RA

patients without evident HF decreases NT-proBNP levels by around 18%.

This suggests no treatment-induced deterioration in cardiac function,

and a potential CV risk benefit.

http://ard.bmj.com/cgi/content/abstract/ard.2009.119412v1?papetoc

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