Acute heart failure as an adverse event of tumor necrosis factor inhibitor therapy in inflammatory bowel disease: A review of the literature

Abstract

Tumor necrosis factor inhibitors (anti-TNFs) are widely used therapies for the treatment of inflammatory bowel diseases (IBD); however, their administration is not risk-free. Heart failure (HF), although rare, is a potential adverse event related to administration of these medications. However, the exact mechanism of development of HF remains obscure. TNFα is found in both healthy and damaged hearts. Its effects are concentration- and receptor-dependent, promoting either cardio-protection or cardiomyocyte apoptosis. Experimental rat models with TNFα receptor knockout showed increased survival rates, less reactive oxygen species formation, and improved diastolic left ventricle pressure. However, clinical trials employing anti-TNF therapy to treat HF had disappointing results, suggesting abolishment of the cardioprotective properties of TNFα, making cardiomyocytes susceptible to apoptosis and oxidation. Thus, patients with IBD who have risk factors should be screened for HF before initiating anti-TNF therapy. This review aims to discuss adverse events associated with the administration of anti-TNF therapy, with a focus on HF, and propose some approaches to avoid cardiac adverse events in patients with IBD.

Keywords: Tumor necrosis factor inhibitors; Inflammatory bowel disease; Heart failure; Adverse event; TNFα receptor

Core Tip: Tumor necrosis factor inhibitors (anti-TNFs) are widely used for the treatment of inflammatory bowel diseases (IBD). However, heart failure, although rare, is an adverse event associated with the use of anti-TNFs in these patients. This review discusses the adverse events, especially heart failure, associated with the administration of anti-TNF therapy. We believe that our study makes a significant contribution to the literature because it discusses the current understanding in the field and proposes approaches to avoid the occurrence of adverse events due to anti-TNFs in patients with IBD.