Interleukin-1 blockade in heart failure: an on-treatment and off-treatment cardiorespiratory fitness analysis.

Moroni F; Many centres in USA and Italy
Golino M; Carbone S; Trankle C; Del Buono MG; Talasaz A; Arena
R; Canada JM; Biondi-Zoccai G; Van Tassel B; Abbate A

ESC heart failure. 10(5):3199-3202, 2023 Oct.

AIMS: Interleukin-1 (IL-1) blockade may improve exercise capacity in
patients with heart failure (HF) patients. The extent of the improvement
and its persistence beyond discontinuation of IL-1 blockade is unknown.
METHODS AND RESULTS: The primary objective was to determine changes in
cardiorespiratory fitness and cardiac function on-treatment with IL-1
blocker, anakinra, and off-treatment, after treatment cessation. We
performed cardiopulmonary exercise testing, Doppler echocardiography, and
biomarkers in 73 patients with HF, 37 (51%) females, 52 (71%)
Black-African-American, before and after treatment with anakinra 100 mg
daily. In a subset of 46 patients, testing was also repeated after
treatment cessation. Quality of life was assessed in each patient using
standardized questionnaires. Data are presented as median and
interquartile range. Treatment with anakinra for 4 [2-12] weeks was
associated with a significant improvement in high-sensitivity C-reactive
protein (from 6.2 [3.3-15.4] to 1.4 [0.8-3.4] mg/L, P < 0.001), peak
oxygen consumption (VO2peak , from 13.9 [11.6-16.6] to 15.2 [12.9-17.4]
mL/kg/min, P < 0.001). Ventilatory efficiency, exercise time,
Doppler-derived signs and biomarkers of elevated intracardiac pressures,
and quality-of-life measures also improved with anakinra. In the 46
patients in whom off-treatment data were available 12 [4-12] weeks later,
many of the favourable changes seen with anakinra were largely reversed
(from 1.5 [1.0-3.4] to 5.9 [1.8-13.1], P = 0.001 for C-reactive protein,
and from 16.2 [14.0-18.4] to 14.9 [11.5-17.8] mL/kg/min, P = 0.017, for
VO2peak ).
CONCLUSIONS: These data validate IL-1 as an active and dynamic modulator
of cardiac function and cardiorespiratory fitness in HF.