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CERTOLIZUMAB PEGOL DOES NOT INDUCE DECREASED CARDIAC FUNCTION WHEN USED IN CROHN’S PATIENTS WITH A HISTORY OF INFLIXIMAB-INDUCED DECREASED CARDIAC OUTPUT: 2 CASE REPORTS
HA Shah, SL Wolman
Division of Gastroenterology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario
INTRODUCTION: Anti-TNF medications are mainstays of therapy for Inflammatory Bowel Disease. Heart failure has been recognized as a serious complication in post-marketing surveillance of both Infliximab and Etanercept. Presently, it is not known if this is a class effect and if a trial of another anti-TNF medication is safe. In this report, we describe two patients with Infliximab-induced cardiac dysfunction subsequently treated safely with Certolizumab pegol.
CASE 1: Patient A is a 50 year old male with severe complicated Crohn’s disease for 36 years. Medication exposures have included steroids, 5-ASA, antibiotics, azathioprine, methotrexate and mycophenolate mofetil. He began Infliximab in December 1999. It was stopped in August 2004 following a drop in left ventricular ejection fraction (LVEF) to 56%. Myocardial mechanics studies suggested a drug effect. Due to worsening disease, Infliximab was restarted in September 2006 but stopped after 1 month due to a precipitous drop in LVEF to 48%. Following recovery of cardiac function, Infliximab was resumed in December 2006 at half-dose but stopped in May 2007 after his LVEF fell steadily to 40%. In June 2007, Certolizumab pegol was started and his LVEF is improved on serial echocardiography (56% in September 2007).
CASE 2: Patient B is a 38 year old male with Ileal Crohn’s disease for 21 years. Medications used have included steroids, 5-ASA and azathioprine. He was placed on Infliximab in September 2004 and continued it until March 2007 (total 18 infusions) when it was stopped secondary to persistent global left ventricular dysfunction on 2D echocardiography. In July 2007, he was started on Certolizumab pegol following recovery of his left ventricular function and his cardiac function has remained normal on serial echocardiography.
DISCUSSION: There are currently no recommendations on managing Infliximab-induced heart failure. Based on two patients described here, Certolizumab pegol may be a safe option with similar efficacy. It is important to study this further.