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The use of the tumour necrosis factor antagonist infliximab in heart transplant recipients: two case reports
  1. S Metyas1,
  2. D La1,
  3. D G Arkfeld1
  1. 1
    USC, Keck School of Medicine, Los Angeles, California, USA
  1. Professor D G Arkfeld, University of Southern California, Keck School of Medicine, Department of Medicine – Rheumatology, 2011 Zonal Avenue, HMR 711, Los Angeles, CA 90033, USA; arkfeld{at}

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Inflammatory cytokines, such as tumour necrosis factor alpha (TNF-α), have been implicated in the pathophysiology of heart failure, leading to the hypothesis that TNF inhibition might improve the symptoms of patients with moderate-to-severe cardiac symptoms. Recent data from the Anti-TNF Therapy Against Congestive Heart failure (ATTACH) pilot study, however, suggested that infliximab, a chimeric monoclonal antibody against TNF-α, not only failed to produce clinical benefits, but given at higher doses (10 mg/kg) was associated with a worsening of cardiac symptoms. Conversely, two large-scale trials, RECOVER and RENAISSANCE, examined the effects of infliximab and etanercept in over 2000 patients with heart failure, finding no …

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