Zusammenfassung
In den vergangenen 10 Jahren haben sich die Biologika als wertvolle Erweiterung der therapeutischen Möglichkeiten in der Rheumatologie etabliert und bewährt. Neben ihrer eindrucksvollen Wirksamkeit haben die Biologika auch goße Aufmerksamkeit hinsichtlich ihrer unerwünschten Wirkungen erregt. Dabei wurden die kardiovaskulären Risiken im Schatten des Infekt- und Malignomrisikos weniger intensiv beachtet. Die vorliegende Arbeit gibt einen Überblick über die Datenlage zu den kardiovaskulären Wirkungen und Nebenwirkungen der Biologika.
Abstract
Over the course of the last decade, biologic response modifiers (biologics) have significantly broadened the therapeutic armamentarium in clinical rheumatology. In addition to their impressive efficacy, they have also received considerable attention regarding their adverse effects. In contrast to the risk of severe infections and malignancies, the cardiovascular risk of these drugs has provoked less vigilance. This article reviews the current data on the cardiovascular effects and adverse effects of biologics.
Literatur
Fleischmann RM, Iqbal I, Stern RL (2004) Considerations with the use of biological therapy in the treatment of rheumatoid arthritis. Expert Opin Drug Saf 3:391–403
Hyrich K, Symmons D, Watson K et al (2006) Baseline comorbidity levels in biologic and standard DMARD treated patients with rheumatoid arthritis: results from a national patient register. Ann Rheum Dis 65:895–898
Lin J, Ziring D, Desai S et al (2008) TNFalpha blockade in human diseases: an overview of efficacy and safety. Clin Immunol 126:13–30
Deswal A, Bozkurt B, Seta Y et al (1999) Safety and efficacy of a soluble P75 tumor necrosis factor receptor (Enbrel, etanercept) in patients with advanced heart failure. Circulation 99:3224–3226
Torre-Amione G, Kapadia S, Lee J et al (1996) Tumor necrosis factor-alpha and tumor necrosis factor receptors in the failing human heart. Circulation 93:704–711
Bozkurt B, Torre-Amione G, Warren MS et al (2001) Results of targeted anti-tumor necrosis factor therapy with etanercept (ENBREL) in patients with advanced heart failure. Circulation 103:1044–1047
Fichtlscherer S, Rossig L, Breuer S et al (2001) Tumor necrosis factor antagonism with etanercept improves systemic endothelial vasoreactivity in patients with advanced heart failure. Circulation 104:3023–3025
Anker SD, Coats AJ (2002) How to RECOVER from RENAISSANCE? The significance of the results of RECOVER, RENAISSANCE, RENEWAL and ATTACH. Int J Cardiol 86:123–130
Mann DL, McMurray JJ, Packer M et al (2004) Targeted anticytokine therapy in patients with chronic heart failure: results of the Randomized Etanercept Worldwide Evaluation (RENEWAL). Circulation 109:1594–1602
Chung ES, Packer M, Lo KH et al (2003) Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial. Circulation 107:3133–3140
Kwon HJ, Cote TR, Cuffe MS et al (2003) Case reports of heart failure after therapy with a tumor necrosis factor antagonist. Ann Intern Med 138:807–811
Crowson CS, Nicola PJ, Kremers HM et al (2005) How much of the increased incidence of heart failure in rheumatoid arthritis is attributable to traditional cardiovascular risk factors and ischemic heart disease? Arthritis Rheum 52:3039–3044
Curtis JR, Kramer JM, Martin C et al (2007) Heart failure among younger rheumatoid arthritis and Crohn’s patients exposed to TNF-alpha antagonists. Rheumatology (Oxford) 46:1688–1693
Wolfe F, Michaud K (2004) Heart failure in rheumatoid arthritis: rates, predictors, and the effect of anti-tumor necrosis factor therapy. Am J Med 116:305–311
Bernatsky S, Hudson M, Suissa S (2005) Anti-rheumatic drug use and risk of hospitalization for congestive heart failure in rheumatoid arthritis. Rheumatology (Oxford) 44:677–680
Carmona L, Descalzo MA, Perez-Pampin E et al (2007) All-cause and cause-specific mortality in rheumatoid arthritis are not greater than expected when treated with tumour necrosis factor antagonists. Ann Rheum Dis 66:880–885
Listing J, Strangfeld A, Kekow J et al (2008) Does tumor necrosis factor alpha inhibition promote or prevent heart failure in patients with rheumatoid arthritis? Arthritis Rheum 58:667–677
Maini RN, Taylor PC, Szechinski J et al (2006) Double-blind randomized controlled clinical trial of the interleukin-6 receptor antagonist, tocilizumab, in European patients with rheumatoid arthritis who had an incomplete response to methotrexate. Arthritis Rheum 54:2817–2829
Genovese MC, McKay JD, Nasonov EL et al (2008) Interleukin-6 receptor inhibition with tocilizumab reduces disease activity in rheumatoid arthritis with inadequate response to disease-modifying antirheumatic drugs: the tocilizumab in combination with traditional disease-modifying antirheumatic drug therapy study. Arthritis Rheum 58:2968–2980
Emery P, Keystone E, Tony HP et al (2008) IL-6 receptor inhibition with tocilizumab improves treatment outcomes in patients with rheumatoid arthritis refractory to anti-tumour necrosis factor biologicals: results from a 24-week multicentre randomised placebo-controlled trial. Ann Rheum Dis 67:1516–1523
Smolen JS, Beaulieu A, Rubbert-Roth A et al (2008) Effect of interleukin-6 receptor inhibition with tocilizumab in patients with rheumatoid arthritis (OPTION study): a double-blind, placebo-controlled, randomised trial. Lancet 371:987–997
Jones G, Sebba A, Gu J et al (2010) Comparison of tocilizumab monotherapy versus methotrexate monotherapy in patients with moderate to severe rheumatoid arthritis: the AMBITION study. Ann Rheum Dis 69:88–96
Nishimoto N, Miyasaka N, Yamamoto K et al (2009) Long-term safety and efficacy of tocilizumab, an anti-IL-6 receptor monoclonal antibody, in monotherapy, in patients with rheumatoid arthritis (the STREAM study): evidence of safety and efficacy in a 5-year extension study. Ann Rheum Dis 68:1580–1584
Popa C, Netea MG, Radstake T et al (2005) Influence of anti-tumour necrosis factor therapy on cardiovascular risk factors in patients with active rheumatoid arthritis. Ann Rheum Dis 64:303–305
Popa C, Hoogen FH van den, Radstake TR et al (2007) Modulation of lipoprotein plasma concentrations during long-term anti-TNF therapy in patients with active rheumatoid arthritis. Ann Rheum Dis 66:1503–1507
Rantapää Dahlqvist S, Engstrand S, Berglin E et al (2006) Conversion towards an atherogenic lipid profile in rheumatoid arthritis patients during long-term infliximab therapy. Scand J Rheumatol 35:107–111
Eijk IC van, Vries MK de, Levels JHM et al (2009) Improvement of lipid profile is accompanied by atheroprotective alterations in high-density lipoprotein composition upon tumor necrosis factor blockade: a prospective cohort study in ankylosing spondylitis. Arthritis Rheum 60:1324
Kerekes G, Soltesz P, Der H et al (2009) Effects of rituximab treatment on endothelial dysfunction and lipid profile in rheumatoid arthritis. Clin Rheumatol 28:705
Saiki O (2007) Infliximab but not methotrexate induces extra-high levels of VLDL-triglyceride in patients with rheumatoid arthritis. J Rheumatol 34:1997
Hürlimann D, Forster A, Noll G et al (2002) Anti-tumor necrosis factor-[alpha] treatment improves endothelial function in patients with rheumatoid arthritis. Circulation 106:2184
Gonzalez-Juanatey C, Llorca J, Sanchez-Andrade A et al (2006) Short-term adalimumab therapy improves endo-thelial function in patients with rheumatoid arthritis refractory to infliximab. Clin Exp Rheumatol 24:309–312
Gonzalez-Juanatey C, Testa A, Garcia-Castelo A et al (2004) Active but transient improvement of endothelial function in rheumatoid arthritis patients undergoing long-term treatment with anti-tumor necrosis factor alpha antibody. Arthritis Rheum 51:447–450
Gonzalez-Juanatey C, Llorca J, Garcia-Porrua C et al (2006) Effect of anti-tumor necrosis factor alpha therapy on the progression of subclinical atherosclerosis in severe rheumatoid arthritis. Arthritis Rheum 55:150–153
Di Micco P, Ferrazzi P, Librè L et al (2009) Intima-media thickness evolution after treatment with infliximab in patients with rheumatoid arthritis. Int J Gen Med 2:141–144
Van Doornum S, McColl G, Wicks IP (2005) Tumour necrosis factor antagonists improve the disease activity but not arterial stiffness in rheumatoid arthritis. Rheumatology (Oxford) 44:1428
Bilsborough W, Keen H, Taylor A et al (2006) Anti-tumour necrosis factor-[alpha] therapy over conventional therapy improves endothelial function in adults with rheumatoid arthritis. Rheumatol Int 26:1125
Sidiropoulos PI, Siakka P, Pagonidis K et al (2009) Sustained improvement of vascular endothelial function during anti-TNF[alpha] treatment in rheumatoid arthritis patients. Scand J Rheumatol 38:6
Wong M, Oakley SP, Young L et al (2008) Infliximab improves vascular stiffness in patients with rheumatoid arthritis. Ann Rheum Dis 68:1277
Del Porto F, Lagana B, Lai S et al (2007) Response to anti-tumour necrosis factor alpha blockade is associated with reduction of carotid intima-media thickness in patients with active rheumatoid arthritis. Rheumatology (Oxford) 46:1111–1115
Solomon DH, Avorn J, Katz JN et al (2006) Immunosuppressive medications and hospitalization for cardiovascular events in patients with rheumatoid arthritis. Arthritis Rheum 54:3790–3798
Dixon WG, Watson KD, Lunt M et al (2007) Reduction in the incidence of myocardial infarction in patients with rheumatoid arthritis who respond to anti-tumor necrosis factor alpha therapy: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum 56:2905–2912
Interessenkonflikt
Der korrespondierende Autor weist auf folgende Beziehungen hin: Vertragshonorare der Firmen Roche, Chugai, Abbott, Wyeth, Bristol Myers Squibb, Actelion.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tarner, I., Müller-Ladner, U. & Hamm, C. Biologika und kardiovaskuläres Risiko. Z. Rheumatol. 69, 702–711 (2010). https://doi.org/10.1007/s00393-009-0583-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00393-009-0583-7