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<p>We examined current evidence regarding the effects of anti-inflammatory therapies in patients with acute heart failure (AHF) on the risk of cardiovascular outcomes, inflammatory markers, natriuretic peptides, and renal function. Despite growing evidence that inflammation plays a pivotal role in both the development and progression of heart failure, including AHF, only a few trials have been conducted to date in patients with AHF. A systematic literature search of PubMed, Medline, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov was conducted in November 2024 to identify randomized controlled trials (RCTs) evaluating anti-inflammatory therapies in adult patients with AHF. Meta-analyses were conducted to estimate effects on clinical outcomes (death, HF readmission, or worsening HF) and inflammatory and other markers. Five RCTs were identified that enrolled a total of 289 patients to an anti-inflammatory intervention and 273 to a control. Prednisone was examined in two RCTs, anakinra in two, and colchicine in one. Three of the five trials required elevated C-reactive protein (CRP) level for entry. Anti-inflammatory therapy was associated with a reduced risk of the composite outcome (hazard ratio 0.55 [95% CI 0.35–0.86]) and an overall 54% greater reduction in CRP to end of therapy (ratio of geometric mean ratios 0.46 [95% CI 0.29–0.73]), which varied across studies. NT-proBNP and creatinine were not significantly affected. The analysis is limited by the small number of studies but suggests that anti-inflammatory therapy reduces inflammation and may reduce the risk of adverse clinical outcomes in patients with AHF.</p> Graphical Abstract <p></p>

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Effects of anti-inflammatory therapy in acute heart failure: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年2月12日

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  • Beth A. Davison,
  • Antonio Abbate,
  • Gad Cotter,
  • Domingo Pascual-Figal,
  • Benjamin Van Tassell,
  • Julio Núñez Villota,
  • Lina Atabaeva,
  • Yonathan Freund,
  • Alberto Aimo,
  • Jan Biegus,
  • Michele Golino,
  • Marco Giuseppe Del Buono,
  • Ovidiu Chioncel,
  • Alain Cohen-Solal,
  • Christopher Edwards,
  • Noelia Fernández-Villa,
  • Gerasimos Filippatos,
  • José Ramón González-Juanatey,
  • Hamlet Hayrapetyan,
  • Borja Ibáñez,
  • Pau Llàcer Iborra,
  • Francesco Moroni,
  • Jozine M. ter Maaten,
  • Roshanak Markley,
  • Javier González-Martín,
  • Manuel Martínez-Sellés,
  • Mayranush Drambyan,
  • Marco Metra,
  • Sonia Mirabet,
  • Andranik Mshetsyan,
  • Maria Novosadova,
  • Matteo Pagnesi,
  • Piotr Ponikowski,
  • Alejandro Riquelme-Pérez,
  • Malha Sadoune,
  • Manuel Anguita Sánchez,
  • Tabassome Simon,
  • Mikel Taibo-Urquía,
  • Koji Takagi,
  • Sandra Villar,
  • Chao Liu,
  • Adriaan A. Voors,
  • Alexandre Mebazaa,
  • Douglas L. Mann,
  • Antoni Bayés-Genís

摘要

We examined current evidence regarding the effects of anti-inflammatory therapies in patients with acute heart failure (AHF) on the risk of cardiovascular outcomes, inflammatory markers, natriuretic peptides, and renal function. Despite growing evidence that inflammation plays a pivotal role in both the development and progression of heart failure, including AHF, only a few trials have been conducted to date in patients with AHF. A systematic literature search of PubMed, Medline, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov was conducted in November 2024 to identify randomized controlled trials (RCTs) evaluating anti-inflammatory therapies in adult patients with AHF. Meta-analyses were conducted to estimate effects on clinical outcomes (death, HF readmission, or worsening HF) and inflammatory and other markers. Five RCTs were identified that enrolled a total of 289 patients to an anti-inflammatory intervention and 273 to a control. Prednisone was examined in two RCTs, anakinra in two, and colchicine in one. Three of the five trials required elevated C-reactive protein (CRP) level for entry. Anti-inflammatory therapy was associated with a reduced risk of the composite outcome (hazard ratio 0.55 [95% CI 0.35–0.86]) and an overall 54% greater reduction in CRP to end of therapy (ratio of geometric mean ratios 0.46 [95% CI 0.29–0.73]), which varied across studies. NT-proBNP and creatinine were not significantly affected. The analysis is limited by the small number of studies but suggests that anti-inflammatory therapy reduces inflammation and may reduce the risk of adverse clinical outcomes in patients with AHF.

Graphical Abstract