Differential Impact of Biologic Therapy on Heart Function Biomarkers in Rheumatoid Arthritis Patients: Observational Study on Etanercept, Adalimumab, and Tocilizumab

Abstract

Background: Rheumatoid arthritis (RA) represents the most frequent form of inflammatory arthritis affecting approximately 1% of the population worldwide. Introduction of novel therapeutic strategies targeting proinflammatory cytokines (TNF-α and interleukin-6) revolutionized the treatment of RA. This kind of treatment, although effective in a substantial portion of patients, may potentially cause many side effects. Among them cardiovascular safety is one of the main concerns. Objectives: In the present study, we investigated what impact treatment with anti-TNF-α and anti-IL-6 agents may have on heart function and levels of heart function biomarkers Methods: To measure this, we used cardiac function biomarkers such as NT-pro Brain Natriuretic Peptide, mid regional pro Atrial Natriuretic Peptide, Galectin-3 and Heart-Type Fatty Acid-Binding Protein and compared them to patients treated with methotrexate as well as healthy controls. Results: Patients treated with biologics were characterized by low disease activity or were in remission. The disease activity in these groups were significantly lower in comparison to the methotrexate group. All patient recruited to the study were characterized by normal heart function measured with the use of echocardiography (EF>50%). With the exception of MR-proANP between tocilizumab and adalimumab (median: 1.01 vs 0.49 nmol/L, p < 0.05), we failed to observe any significant differences in biomarkers levels between groups treated with biologics. Contrary to this, patients on MTX showed higher NT-proBNP levels compared to adalimumab, and healthy controls (p < 0.05 for both). Striking differences have been shown in regard to H-FABP. The levels of these biomarkers were elevated in all biologics and the methotrexate group as compared to healthy controls. Conclusion: As this biomarker reflects potential heart injury we suggest that heart damage proceeds in continuous manner in RA patients despite effective treatment and attainment of remission/low disease activity. This finding however should be verify in larger cohort of RA patients to ascertain if routine assessment of H-FABP may be useful for detection of patients with RA who are at risk of development of heart damage.

Fatty Acid-Binding Proteins in Psoriasis—A Review

“…As for drugs commonly used in daily medical practice, there are reports on the lowering effect of statins, angiotensin II receptor blockers, or sitagliptin, and the elevating influence of pioglitazone on FABP-4 concentration [36]. There was also a study on the impact of anti-TNFα and anti-IL-6 agents on FABP-3, but it was performed on the group with rheumatoid arthritis [66]. After administration of adalimumab and tocilizumab, as well as methotrexate to some subjects, FABP-3 levels were higher compared to the control group [66].…”

“…There was also a study on the impact of anti-TNFα and anti-IL-6 agents on FABP-3, but it was performed on the group with rheumatoid arthritis [66]. After administration of adalimumab and tocilizumab, as well as methotrexate to some subjects, FABP-3 levels were higher compared to the control group [66]. The authors concluded that heart damage progresses in patients with rheumatoid arthritis and this matter should be investigated on a larger sample size [66].…”