Update of TNF-alpha antagonists and cardiovascular disease in rheumatoid arthritis.
Tumor necrosis factor-alpha (TNF-alpha) antagonists were unexpectedly found to have no beneficial effects in moderate-to-severe heart failure in two large randomized clinical trials. In certain doses, the agents were found to be harmful. These results have important implications for rheumatoid arthritis (RA). Patients with the disease have an increased risk for developing cardiovascular co-morbidity, including heart failure. Because of the beneficial effect of the TNF-alpha antagonists in the management of RA, these agents have gained widespread use. Rheumatologists and other physicians who provide care for RA are thus likely to encounter candidates for anti-TNF-alpha therapy who have overt or subclinical heart failure. Although data are currently not sufficient to support evidence-based recommendations, it is possible to make reasonable suggestions to guide clinical practice.
del Rincón
Inmaculada
I
University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA. delrincon@uthscsa.edu
Escalante
Agustín
A
D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D009363:Neoplasm Proteins / Q000627:therapeutic use*; D011956:Receptors, Cell Surface / Q000627:therapeutic use*; D047889:Receptors, Tumor Necrosis Factor, Type II / Q000627:therapeutic use*; D016896:Treatment Outcome; D053319:Tumor Necrosis Factor Decoy Receptors
D009363:Neoplasm Proteins; D011956:Receptors, Cell Surface; D047889:Receptors, Tumor Necrosis Factor, Type II; D053319:Tumor Necrosis Factor Decoy Receptors