Tumour necrosis factor   blockade reduces circulating N-terminal pro-brain natriuretic peptide levels in patients with active rheumatoid arthritis: results from a prospective cohort study

Peters, Mike J L; Welsh, Paul; McInnes, Iain B.; Wolbink, Gertjan; Dijkmans, Ben A. C.; Sattar, Naveed; Nurmohamed, Michael T.

doi:10.1136/ard.2009.119412

Cited by 55 publications

(36 citation statements)

References 35 publications

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“…In our study, acute infliximab administration led to significant increase in NT-proBNP levels but long-term treatment showed tendency to decrease the NT-proBNP levels [72]. Similar, but significant, positive effects of long-term TNFα inhibitors treatment (infliximab, adalimumab) were confirmed by other authors in RA patients without previous HF [71,76].…”

Section: How Do Tnfα Blockers Influence Heart Function In Patients Wisupporting

confidence: 87%

Cardiac Impairment in Rheumatoid Arthritis and Influence of Anti-TNFα Treatment

Lazúrová

Tomáš

2016

Clinic Rev Allerg Immunol

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There is evidence that rheumatoid arthritis (RA) is associated with higher overall and cardiovascular (CV) morbidity and mortality as compared with general population. Increased prevalence of traditional risk factors and chronic inflammation, that has been recognized as independent CV risk factor, may play an important role in atherosclerosis and subsequently ischemic heart disease development. However, myocardial dysfunction as a result of chronic inflammation and secondarily myocardial fibrosis markedly participates on heart failure development. Proinflammatory cytokines, such as C-reactive protein, tumor necrosis factor alpha (TNFα), interleukins 1 and 6, that are markedly increased in RA, play a role in the acceleration of atherosclerosis as well as myocardial fibrosis development. Several studies documented that increased CV risk was associated with seropositivity, disease activity score, citrullination, and duration of RA. Early detection of heart dysfunction is based on echocardiographic detection of diastolic dysfunction resulting from myocardial inflammation and fibrosis. Some studies showed also higher prevalence of left ventricular systolic dysfunction and increased prevalence of cardiac arrhythmias as compared to non-RA population. There are still controversies on the impact of NT-proBNP in predicting cardiac impairment in RA patients. Some authors consider it to be a sensitive noninvasive predictor of subclinical CV disease in these patients and also a predictor of all-cause mortality independently on traditional CV risk factors. However, the correlation with parameters of cardiac function was confirmed only in a few studies. The impact of biological treatment on progression of atherosclerosis and heart failure is still controversial and seems to be not harmful in young patients with normal left ventricular function. The effect of biologics, especially anti-TNFα drugs, is probably related to the cardiac function before treatment. Larger prospective clinical, echocardiographic, and magnetic resonance studies are needed.

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Section: How Do Tnfα Blockers Influence Heart Function In Patients Wisupporting

confidence: 87%

Cardiac Impairment in Rheumatoid Arthritis and Influence of Anti-TNFα Treatment

Lazúrová

Tomáš

2016

Clinic Rev Allerg Immunol

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“…У пациентов с длительным РА L. Peters и со-авт. [21] также выявили снижение уровня NT-proBNP на 18% на фоне лечения адалимумабом и связь динамики этого показателя с СОЭ. Имеется всего лишь одно иссле-дование, продемонстрировавшее снижение уровня NTproBNP на 17% на фоне комбинированной терапии МТ и инфликсимабом [31].…”

Section: Discussionunclassified

“…Кроме того, в упомянутых работах методы оценки сер-дечной функции различны. В большинстве из них ис-пользовались только клинические и эхокардиографиче-ские данные [17][18][19][20][21]. Известно несколько исследова-ний, где проводилось определение N-терминального натрийуретического пептида (NT-proBNP) в качестве маркера ХСН [22,23].…”

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“…Известно несколько исследова-ний, где проводилось определение N-терминального натрийуретического пептида (NT-proBNP) в качестве маркера ХСН [22,23]. Выявлено, что применение бло-каторов ФНОα уменьшают уровень NT-proBNP у паци-ентов с РА примерно на 18% [21].…”

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Impact of Antirheumatic Therapy on the Level of N-Terminal Pro-Brain Natriuretic Peptide in Patients With Early Rheumatoid Arthritis

Kirillova¹,

Новикова²,

Попкова³

et al. 2018

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Objective: to investigate the impact of antirheumatic therapy carried out according to the treat-to-target (T2T) principle on the time course of changes in NT-proBNP levels in patients with early rheumatoid arthritis (RA) over an 18- month follow-up period.Subjects and methods. The investigation enrolled 74 patients, comprising 56 (74%) women (median age, 54 years) with a reliable diagnosis of RA (ACR/AULAR criteria (2010)) (disease duration, 7 months); who were seropositive for IgM rheumatoid factor (87%) and/or anti-cyclic citrullinated peptide antibodies (100%) and had not previously taken disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids. All the patients started therapy with subcutaneous methotrexate (MTX), with escalation of the dose to 25-30 mg/week; in the absence of any effect after 3 months, biological agents (BAs) were added in 47 (71%) patients. Following 18 months, 44% of patients achieved RA remission; 51 patients (77%) received cardioprotective therapy. NT-proBNP levels were measured in 66 patients with early RA before and 18 months after treatment. The NT-proBNP value <125 pg/ml was taken to be normal.Results and discussion. During antirheumatic therapy, there was a decrease in the median level of NT-proBNP from 125 [65; 208] to 68 [33; 115] pg/ml (p < 0.05) and in the frequency of its elevated values from 49 to 21% (p < 0.02). In the patients with RA remission, there was a more pronounced decrease in the frequency of elevated NT-proBNP values (from 45 to 7%; p < 0.05), while in those who had not achieved RA remission, NT-proBNP values showed only a tendency to decrease (from 51 to 32%; p < 0.05). The level of NT-proBNP became normal in the patients who had achieved remission of RA during treatment. There was no progression of the existing chronic heart failure (CHF) or development of its new cases.Conclusion. A significant decrease in NT-proBNP levels was recorded during antirheumatic therapy performed according to the T2T strategy, especially when using a combination of MTX+BAs and achieving RA remission. Therapy with MTX and BAs did not lead to the worsening of CHF or to the development of its new cases in patients with early RA.

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“…M.J. Peters и соавт. [84] проанализировано влияние АДА на уровень NT-proBNP у больных с высокой активностью РА без признаков сердеч-ной недостаточности. Через 4 мес лечения наблюдалось снижение его концентрации в среднем на 18%, при этом из-менение значений NT-proBNP коррелировало со снижени-ем уровня СОЭ, пульсового и систолического АД.…”

Section: Lt Jacobsson и соавт [57]unclassified

Ihmor necrosis factor-a inhibitors and cardiovascular risk in rheumatoid arthritis

Попкова¹,

Новикова²,

Насонов³

2012

Modern Rheumatology Journal

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Tumour necrosis factor blockade reduces circulating N-terminal pro-brain natriuretic peptide levels in patients with active rheumatoid arthritis: results from a prospective cohort study

Abstract: These observations show that blocking TNFalpha in patients with RA without evident heart failure decreases NT-proBNP levels by about 18%. This suggests no treatment-induced deterioration in cardiac function and a potential cardiovascular risk benefit.

Cited by 55 publications

References 35 publications

Cardiac Impairment in Rheumatoid Arthritis and Influence of Anti-TNFα Treatment

Cardiac Impairment in Rheumatoid Arthritis and Influence of Anti-TNFα Treatment

Impact of Antirheumatic Therapy on the Level of N-Terminal Pro-Brain Natriuretic Peptide in Patients With Early Rheumatoid Arthritis

Ihmor necrosis factor-a inhibitors and cardiovascular risk in rheumatoid arthritis

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