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I Ikonomidis, G Pavlidis, P Katsimbri, I Andreadou, H Triantafyllidi, M Varoudi, G Kostelli, D Benas, C Triantafyllis, P Efentakis, A R Vrettou, A Frogoudaki, J Lekakis, D Boumpas, E Iliodromitis, P5426
Effects of inhibition of interleukin 1 and 6 activity on myocardial and vascular function compared with prednisolone in patients with rheumatoid arthritis, European Heart Journal, Volume 39, Issue suppl_1, August 2018, ehy566.P5426, https://doi.org/10.1093/eurheartj/ehy566.P5426Close - Share Icon Share
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Background: Interleukin 1 and 6 mediate atherogenesis and coronary vasoreactivity. Anakinra, a recombinant form of human interleukin-1 receptor antagonist and tocilizumab, a humanised monoclonal antibody against the human interleukin-6 receptor, are used for the treatment of rheumatoid arthritis (RA). We investigated the effects of anakinra and tocilizumab on myocardial and vascular function in RA patients.
Methods: Seventy five patients with RA (age: 63±10years) were randomized to receive anakinra (n=30), tocilizumab (n=30), or prednisolone (n=15) for 3 months. At baseline and after 3-month treatment we assessed: a)LV longitudinal strain (GLS), systolic (LongSr) and diastolic (LongSrE) strain rate using speckle tracking echocardiography, b)Flow mediated dilatation (FMD%) of the brachial artery after hyperemia, c)coronary flow reserve (CFR) of the LAD using Doppler echocardiography and d)malondialdehyde (MDA) and protein carbonyls (PCs) plasma levels.
Results: Compared with baseline, all patients had improved GLS (-16.6% versus -18.5%), CFR (2.4 versus 2.6), and MDA (1.94 versus 1.5 μM/L) post-treatment. Compared with tocilizumab and prednisolone, anakinra treatment resulted in a greater improvement of GLS (27% versus 21% versus 19%). Compared with anakinra and prednisolone, tocilizumab resulted in a greater improvement of CFR (30% versus 25% versus 22%), FMD% (11.6% versus 10.5% versus 4.3%), as well as a greater reduction of MDA (35% versus 12% versus 5%, Fig. 1) (p<0.05 for all comparisons). In all patients the percent decrease of MDA was correlated with percent increase of GLS (r=0.74, p<0.001). After treatment with tocilizumab, the percent increase in CFR was related with changes in FMD% (r=0.63) and GLS (r=0.57) (p<0.05 for all associations).
