TY - JOUR
T1 - Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-α, in patients with moderate-to-severe heart failure
T2 - Results of the anti-TNF therapy against congestive heart failure (ATTACH) trial
AU - Chung, Eugene S.
AU - Packer, Milton
AU - Lo, Kim Hung
AU - Fasanmade, Adedigbo A.
AU - Willerson, James T.
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2003/7/1
Y1 - 2003/7/1
N2 - Background - Preclinical and preliminary clinical data have suggested that tumor necrosis factor-α (TNFα) may play a role in the evolution and progression of heart failure and that inhibition of TNFα may favorably modify the course of the disease. We evaluated the efficacy and safety of infliximab, a chimeric monoclonal antibody to TNFα, in patients with moderate-to-severe heart failure. Methods and Results - One hundred fifty patients with stable New York Heart Association class III or IV heart failure and left ventricular ejection fraction ≤ 35% were randomly assigned to receive placebo (n=49), infliximab 5 mg/kg (n=50), or infliximab 10 mg/kg (n=51) at 0, 2, and 6 weeks after randomization and were followed-up prospectively for 28 weeks. Neither dose of infliximab improved clinical status at 14 weeks, the primary endpoint of the study, despite suppression of inflammatory markers (C-reactive protein and interleukin-6) and a modest increase in ejection fraction in the patients receiving 5 mg/kg (P=0.013). Furthermore, after 28 weeks, 13, 10, and 20 patients were hospitalized for any reason in the placebo, 5 mg/kg infliximab, and 10 mg/kg infliximab groups, respectively. The combined risk of death from any cause or hospitalization for heart failure through 28 weeks was increased in the patients randomized to 10 mg/kg infliximab (hazard ratio 2.84, 95% confidence interval 1.01 to 7.97; nominal P=0.043). Conclusions - Short-term TNFα antagonism with infliximab did not improve and high doses (10 mg/kg) adversely affected the clinical condition of patients with moderate-to-severe chronic heart failure.
AB - Background - Preclinical and preliminary clinical data have suggested that tumor necrosis factor-α (TNFα) may play a role in the evolution and progression of heart failure and that inhibition of TNFα may favorably modify the course of the disease. We evaluated the efficacy and safety of infliximab, a chimeric monoclonal antibody to TNFα, in patients with moderate-to-severe heart failure. Methods and Results - One hundred fifty patients with stable New York Heart Association class III or IV heart failure and left ventricular ejection fraction ≤ 35% were randomly assigned to receive placebo (n=49), infliximab 5 mg/kg (n=50), or infliximab 10 mg/kg (n=51) at 0, 2, and 6 weeks after randomization and were followed-up prospectively for 28 weeks. Neither dose of infliximab improved clinical status at 14 weeks, the primary endpoint of the study, despite suppression of inflammatory markers (C-reactive protein and interleukin-6) and a modest increase in ejection fraction in the patients receiving 5 mg/kg (P=0.013). Furthermore, after 28 weeks, 13, 10, and 20 patients were hospitalized for any reason in the placebo, 5 mg/kg infliximab, and 10 mg/kg infliximab groups, respectively. The combined risk of death from any cause or hospitalization for heart failure through 28 weeks was increased in the patients randomized to 10 mg/kg infliximab (hazard ratio 2.84, 95% confidence interval 1.01 to 7.97; nominal P=0.043). Conclusions - Short-term TNFα antagonism with infliximab did not improve and high doses (10 mg/kg) adversely affected the clinical condition of patients with moderate-to-severe chronic heart failure.
KW - Antibodies
KW - Heart failure
KW - Proteins
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U2 - 10.1161/01.CIR.0000077913.60364.D2
DO - 10.1161/01.CIR.0000077913.60364.D2
M3 - Article
C2 - 12796126
AN - SCOPUS:0038755661
SN - 0009-7322
VL - 107
SP - 3133
EP - 3140
JO - Circulation
JF - Circulation
IS - 25
ER -