TNF-alpha inhibitors and congestive heart failure.
Tumor necrosis factor-alpha inhibitors are among the new class of drugs that offer new options for psoriasis control. In addition to serving as a key mediator in psoriasis, elevated tumor necrosis factor-alpha levels have also been observed in patients with congestive heart failure, and clinical trials have been performed to examine the effects of tumor necrosis factor-alpha inhibitors, such as etanercept and infliximab, in such a population. Two large-scale trials examining the effects of etanercept in more than 2000 patients with heart failure did not indicate any increased risk of mortality or morbidity, and no US Food and Drug Administration warning has been issued regarding the use of etanercept in such a patient population. On the other hand, a study with infliximab showed significantly increased deaths, hospitalizations, and morbidity. Thus, infliximab>5 mg/kg is now contraindicated in patients with moderate-to-severe congestive heart failure (New York Heart Association functional class III/IV). If infliximab must be used, it should not exceed 5 mg/kg, and patients must be followed closely.
Behnam
Shahrad M
SM
Department of Dermatology, University of California School of Medicine at San Francisco, San Francisco, CA 94118, USA.
Behnam
Shahdad E
SE
Koo
John Y
JY
D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy; D002986:Clinical Trials as Topic; D000068800:Etanercept; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use*; D000069285:Infliximab; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000911:Antibodies, Monoclonal; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068800:Etanercept