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

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Arthritis Rheum. 2008 Mar;58(3):667-77.

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

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

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