Dulling a heart failure patient’s overactive immune system may reduce his/her chances of dying from any cause, or being hospitalized in future for cardiovascular reasons, according to an article published in The Lancet. Such IMT (immunomodulation therapy) has potential for treating a large number of heart failure patients.
Patients whose immune systems are stimulated as a result of systolic heart failure often have raised circulating tissue concentrations of inflammatory cytokines – also, there are more autoantibodies specific for a range of cardiac antigens. Some of these molecules could damage the heart, animal studies have indicated. Therefore, modulation of this immune response is an interesting therapeutic target.
Professor Guillermo Torre-Amione, Methodist DeBakey Heart Centre, The Methodist Hospital, Houston, Texas, USA, and carried out a placebo-controlled, double-blind study of a device-based IMT of 2,426 patients. The all had New York Heart Association (NYHA) functional class II-IV chronic heart failure, left ventricular systolic dysfunction, and hospitalization for heart failure or intravenous drug therapy in an outpatient setting within the previous 12 months.
The patients were randomly selected to either receive IMT (1,213) or placebo (1,213). All the patients were treated for a minimum of 22 weeks – the primary endpoint was death from any cause or subsequent first hospitalization for cardiovascular reasons.
During a follow-up period of 10•2 months, there were 399 primary events among the IMT patients and 429 in the placebo group, giving a reduction of risk in the IMT group of 8%. “However, in two prespecified subgroups of patients – those with no history of heart attack (919) and those with NYHA II heart failure (689), IMT was associated with a 26% and 39% reduction in the risk of primary events, respectively,” the authors wrote.
“Our findings suggest a role for non-specific immunomodulation as a potential treatment for a large segment of the heart failure population – including patients without a history of myocardial infarction and those within NYHA class II. However, this hypothesis needs to be tested in an adequately powered confirmatory trial,” the scientists concluded.
“Results of a non-specific immunomodulation therapy in chronic heart failure (ACCLAIM trial): a placebo-controlled randomised trial”
Guillermo Torre-Amione MD email address a Corresponding Author Information, Stefan D Anker MD b, Robert C Bourge MD c, Wilson S Colucci MD d, Barry H Greenberg MD e, Per Hildebrandt MD f, Andre Keren MD g, Michael Motro MD h, Lemuel A Moyé MD i, Jan Erik Otterstad MD j, Craig M Pratt MD a, Piotr Ponikowski MD k, Jean Lucien Rouleau MD l, Francois Sestier MD m, Bernhard R Winkelmann MD n and James B Young MD
The Lancet 2008; 371:228-236 DOI:10.1016/S0140-6736(08)60134-8
Written by – Christian Nordqvist