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Summaries for Patients |20 May 2003

Tumor Necrosis Factor Antagonists and Heart Failure

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Author, Article, and Disclosure Information

  • The summary below is from the full report titled Case Reports of Heart Failure after Therapy with a Tumor Necrosis Factor Antagonist. It is in the 20 May 2003 issue of Annals of Internal Medicine (volume 138, pages 807-811). The authors are H.J. Kwon, T.R. Cot, M.S. Cuffe, J.M. Kramer, and M.M. Braun.


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What is the problem and what is known about it so far?

Heart failure is a condition in which the heart does not pump blood as well as it should, leading to fluid building up in the lungs. Old age, high blood pressure, and coronary artery disease are risk factors for heart failure. Drugs called tumor necrosis factor (TNF) antagonists were once thought to offer hope as a treatment for heart failure, but recent studies showed no benefit and one study actually showed that they could worsen heart failure. These drugs have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of two other conditions, inflammatory bowel disease and rheumatoid arthritis.

Why did the researchers do this particular study?

To find out about patients who had heart failure as a complication when they took TNF antagonists to treat inflammatory bowel disease or rheumatoid arthritis.

Who was studied?

47 patients who developed heart failure while taking TNF antagonists to treat inflammatory bowel disease or rheumatoid arthritis. Health care providers and consumers reported the heart failure complications to the FDA.

How was the study done?

The researchers examined the information in the reports. They looked at whether the patients had had heart failure before taking TNF antagonists and had any conditions that put them at risk for heart failure. Risk factors for heart failure include older age, high blood pressure, and other types of heart or lung disease.

What did the researchers find?

Of the 47 patients who developed symptoms of heart failure while taking TNF antagonists, 9 had had problems with heart failure before starting the drugs. The other 38 developed their first episode of heart failure while taking TNF antagonists. Of these 38, 19 had no risk factors for heart failure. In addition, 10 patients were younger than 50 years of age. When these 10 patients stopped taking the TNF antagonists, the heart failure went away completely in 3 and improved in 6; the remaining patient died.

What were the limitations of the study?

The study was based only on cases that were voluntarily reported to the FDA. There may have been additional cases that nobody reported, so this study does not tell us how frequently this complication occurs.

What are the implications of the study?

Doctors and patients should watch for symptoms of heart failure when using TNF antagonists to treat inflammatory bowel disease or rheumatoid arthritis.

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Tumor Necrosis Factor Antagonists and Heart Failure. Ann Intern Med. 2003;138:I–48. doi: https://doi.org/10.7326/0003-4819-138-10-200305200-00004

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Published: Ann Intern Med. 2003;138(10):I-48.

DOI: 10.7326/0003-4819-138-10-200305200-00004

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2003 American College of Physicians
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