[2007] [THU0186] THE USE OF THE TNF ANTAGONIST INFLIXIMAB IN HEART TRANSPLANT RECIPIENTS: TWO CASE REPORTS

S.K. Metyas, D. La, D.G. Arkfeld Department of Rheumatology, University of Southern California - Keck School of Medicine, Los Angeles, United States

Background: Inflammatory cytokines, such as tumor necrosis factor-alpha (TNF), have been implicated in the pathophysiology of heart failure, leading to the hypothesis that TNF-inhibition might improve the symptoms of patients with moderate-to-severe cardiac symptoms. Recent data from the ATTACH (Anti-TNF Therapy Against Congestive Heart failure) pilot study, however, suggested that Infliximab, a chimeric monoclonal antibody against TNF-alpha, not only failed to produce clinical benefits, but, given at higher doses (10 mg/kg), was associated with worsening of cardiac symptoms.
Objectives: Here we describe two case reports of patients who received TNF antagonist therapy following heart transplant for heart failure
Methods: Patients had a previous history of psoriatic arthritis, diabetes mellitus, and hypertension,as well as other conitions, including hypercholesterolemia and colon cancer (case 1) rheumatoid arthritis, peripheral vascular disease, diabetes (case 2). Standard Infliximab infusions were performed starting at 3mg/kg with titration to benefit. Four years after transplant surgery, case 1 patient is stable from a cardiac and rheumatologic standpoint. Although case 2 patient had a good response to Infliximab treatment, with decreased pain and inflammation resulting in the complete cessation of narcotic medications, and without worsening of her cardiac condition, treatment was discontinued after four months as patient developed bedsores.
Conclusion: The use TNF antagonist therapy after heart transplant was of potential concern in light of the ATTACH study results suggesting the potential for TNF antagonists to precipitate heart failure. Important questions have been raised regarding the potential roles of pro-inflammatory cytokines in heart disease and whether TNF antagonists are safe in heart transplant recipients. Four years after transplant surgery, we observed no complications, from a cardiac standpoint, associated with Infliximab treatment. This is, to our knowledge, the first case study report of the use of TNF antagonists in heart transplant recipients.

RA anti-TNF therapy