Case Reports of Heart Failure after Therapy with a Tumor Necrosis Factor Antagonist

Kwon, Hyon-Jo; Coté, Timothy R.; Cuffe, Michael S.; Kramer, Judith M.; Braun, M. Miles

doi:10.7326/0003-4819-138-10-200305200-00008

Cited by 401 publications

(197 citation statements)

References 12 publications

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“…25 Some of these trials failed to show substantial beneficial effects of these new therapies for CHF. 26 These results raise important questions about the role that cytokines play in the pathogenesis of CHF. Are higher levels of inflammatory markers part of the pathophysiological pathway leading to cardiovascular disease or just an indirect measure of subclinical disease?…”

Section: Discussionmentioning

confidence: 98%

Inflammatory Markers and Onset of Cardiovascular Events

et al. 2003

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Background— Inflammation plays an important role in cardiovascular disease. The aim of this study is to investigate the predictive value of several inflammatory markers on the incidence of cardiovascular events in well-functioning older persons. Methods and Results— The subjects were 2225 participants 70 to 79 years old, without baseline cardiovascular disease, who were enrolled in the Health, Aging, and Body Composition study. Incident coronary heart disease (CHD), stroke, and congestive heart failure (CHF) events were detected during an average follow-up of 3.6 years. Blood levels of interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) were assessed. After adjustment for potential confounders, IL-6 was significantly associated with all outcomes (CHD events, per IL-6 SD increase: RR, 1.27; 95% CI, 1.10 to 1.48; stroke events, per IL-6 SD increase: RR, 1.45; 95% CI, 1.12 to 1.86; CHF events, per IL-6 SD increase: RR, 1.72; 95% CI, 1.40 to 2.12). TNF-α showed significant associations with CHD (per TNF-α SD increase: RR, 1.22; 95% CI, 1.04 to 1.43) and CHF (per TNF-α SD increase: RR, 1.59; 95% CI, 1.30 to 1.95) events. CRP was significantly associated with CHF events (per CRP SD increase: RR, 1.48; 95% CI, 1.23 to 1.78). A composite summary indicator of inflammation showed a strong association with incident cardiovascular events, with an especially high risk if all 3 inflammatory markers were in the highest tertile. Conclusions— Findings suggest that inflammatory markers are independent predictors of cardiovascular events in older persons.

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Section: Discussionmentioning

confidence: 98%

Inflammatory Markers and Onset of Cardiovascular Events

et al. 2003

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“…Kwon et al analysed data from the US Medwatch Program [9] looking for adverse effect reports of heart failure in patients being treated with TNF antagonists. They excluded reports that were associated with other potential precipitants of heart failure such as myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

Heart Failure with Etanercept Therapy: A Case Report

Ma¹,

Dorm²,

Neyses³

et al. 2013

J Clin Exp Cardiolog

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Tumour Necrosis Factor-alpha antagonists constitute an important part of the therapeutic armamentarium available for managing autoimmune diseases such as rheumatoid arthritis and psoriatic arthropathy. Here, we present the case of a 68-year old male with severe rheumatoid arthritis who developed chest pains and severe left ventricular systolic dysfunction following etanercept therapy. Etanercept was discontinued while he was commenced on standard heart failure treatment. This, consequently, led to complete resolution of his symptoms and recovery of left ventricular function to near normal. Previous literature involving similar case reports is reviewed and implications for clinical practice are discussed with emphasis on the need for a screening protocol when commencing such therapy.

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“…Etanercept has been associated with a low incidence of new onset heart failure among patients with no known heart failure risk factors. 30 In addition, the Randomized Etanercept Worldwide Evaluation study failed to show a functional or survival benefit in NYHA class II-IV patients who received etanercept. 11 Patients who receive subcutaneous etanercept develop serum levels that are several thousand-fold higher than that observed in baboons with cardiac expression of TNFRII-Fc.…”

Section: Direct Injection Of Aav-2 Into Baboon Hearts Cf Mctiernan Et Almentioning

confidence: 99%

Myocarditis following adeno-associated viral gene expression of human soluble TNF receptor (TNFRII-Fc) in baboon hearts

et al. 2007

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Sequestration of tumor necrosis factor-a (TNFa) by TNFreceptor immunoglobulin G (IgG)-Fc fusion proteins can limit heart failure progression in rodent models. In this study we directly injected an adeno-associated viruses (AAV)-2 construct encoding a human TNF receptor II IgG-Fc fusion protein (AAV-TNFRII-Fc) into healthy baboon hearts and assessed virally encoded gene expression and clinical response. Adult baboons received direct cardiac injections of AAV-TNFRII-Fc (B5 Â 10 12 viral/genomes/baboon) or an equivalent dose of AAV-2 empty capsids, and were analyzed after 5 or 12 weeks. Viral genomes were restricted to the myocardium, and routine analyses (blood cell counts, clinical chemistries) remained unremarkable. Echocardiograms were unchanged but electrocardiograms revealed marked ST-and T-wave changes consistent with myocarditis only in baboons receiving AAV-TNFRII-Fc. TNFRII serum levels peaked at B3 times the baseline levels at 1-2 weeks postinjection and subsequently declined to baseline levels. TNFRII-Fc protein and transcripts were detected in the heart at harvest. After AAV injection, anti-AAV-2 antibody levels increased in all baboons, while anti-TNFRII-Fc could not be detected. Baboons that received AAV-TNFRII-Fc developed myocardial infiltrates including CD8+ cells. Thus, a cellular immune response to cardiac delivery of AAV encoding foreign proteins may be an important consideration for AAV-based cardiac gene therapy.

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Case Reports of Heart Failure after Therapy with a Tumor Necrosis Factor Antagonist

Abstract: In a fraction of patients, TNF antagonists might induce new-onset heart failure or exacerbate existing disease.

Cited by 401 publications

References 12 publications

Inflammatory Markers and Onset of Cardiovascular Events

Inflammatory Markers and Onset of Cardiovascular Events

Heart Failure with Etanercept Therapy: A Case Report

Myocarditis following adeno-associated viral gene expression of human soluble TNF receptor (TNFRII-Fc) in baboon hearts

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