Anti-TNF Therapy Lowers the Risk of Congestive Heart Failure

Patients with RA are at increased CV risk, with a Standardized Mortality Ratio (SMR) of 1.5 vs. the general population. The purported etiology is thought to be atheroma progression from persistent inflammation combined with traditional CV risk factors. Studies have shown that patients with RA develop Congestive Heart Failure (CHF) at increased rates and this seems to correlate with increased CRP levels. Is the incidence of CHF reduced by anti-TNF therapy?

Is the incidence of Congestive Heart Failure (CHF) reduced by anti-TNF therapy? This question was addressed in the oral presentation of Abstract 1909.

Investigators from the British Society for Rheumatology Biologics Register (BSRBR) compared the rates of validated CHF among anti-TNF users vs. a non-biologic DMARD (nbDMARD) control group. Patients with secondary causes of CHF (e.g., arrhythmia, valvular disease, etc) were excluded. CHF was defined according to the Framingham criteria and verified by a consultant cardiologist.

The nbDMARD group included 3,662 patients vs. 12,397 in the anti-TNF group. Patients in the nbDMARD group were older but patients in the anti-TNF group had longer disease duration, higher disease activity, and used more steroids.

From 2001-2013, 397 cases of CHF were identified. Only 87 were included in this analysis. The remaining 310 were excluded because there was another identifiable cause of CHF or the diagnosis of CHF could not be accurately verified.

There were 48 cases of CHF in the nbDMARD group over 18,698 patient-years of exposure vs. 39 cases in the anti-TNF group over 62,224 patient-years of exposure. The incidence rate of CHF was 25.7 per 10,000 pt-years (19.5-34.4) in the nbDMARD group vs. 6.3 per 10,000 pt-years (4.6-6.8) in the anti-TNF group, with an adjusted Hazard Ratio (HR) of 0.25 for the anti-TNF group vs. the nbDMARD group.

The limitations of this study include possible under-reporting of non-fatal CHF and a channeling bias of patients with CHF risk to treatment with nbDAMRDs.

In conclusion, patients receiving anti-TNF therapy have a lower risk of CHF vs. those treated with non-biologic DMARDs.

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