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Published on: May 28, 2019
Response to interleukin-1 blockade with anakinra in women and men with ST-segment elevation myocardial infarction
Giuliana Corna1,2, Michele Golino1,3, Azita H Talasaz4
1Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.
Insights
Anakinra treatment for ST-segment myocardial infarction (STEMI) reduced inflammation and heart failure events in both men and women. Despite higher baseline inflammation in women, they experienced similar benefits from anakinra, suggesting its efficacy across sexes.
Area of Science:
- Cardiology
- Immunology
- Pharmacology
Background:
- Interleukin-1 blockade with anakinra effectively reduces high-sensitivity C-reactive protein (hsCRP) and prevents heart failure (HF) post-ST-segment myocardial infarction (STEMI).
- Sex-based differences in STEMI patient outcomes are known, but the specific response to anakinra in women versus men remains uncharacterized.
Purpose of the Study:
- To investigate sex-based differences in systemic inflammation and the composite endpoint of new-onset HF or death in STEMI patients treated with anakinra.
- To evaluate the efficacy of anakinra in reducing hsCRP levels and preventing adverse cardiovascular events in both women and men post-STEMI.
Main Methods:
- Analysis of data from three Virginia Commonwealth University Anakinra Response Trial (VCUART) randomized clinical trials.
- Comparison of systemic inflammation (hsCRP levels and area under the curve) and the composite endpoint of new-onset HF or death between anakinra and placebo groups, stratified by sex.
Main Results:
- A total of 139 patients (21% women) were analyzed. Baseline hsCRP was significantly higher in women than men.
- Anakinra treatment numerically reduced hsCRP-AUC and the composite endpoint of HF or death in both men and women compared to placebo.
- No statistically significant differences were observed between women and men in their response to anakinra regarding hsCRP-AUC or the composite endpoint.
Conclusions:
- Women were underrepresented in the VCUART trials and presented with higher baseline hsCRP levels.
- Despite higher baseline inflammation, women appeared to benefit similarly to men from anakinra treatment in STEMI.
- Anakinra demonstrates potential for similar efficacy in reducing inflammation and preventing HF events in both sexes after STEMI.
Background:
Interleukin-1 blockade with anakinra reduces high-sensitivity C-reactive protein (hsCRP) levels and prevents heart failure (HF) events after ST-segment myocardial infarction (STEMI). Sex-based differences in STEMI patients have been reported, but no data are available regarding response to anakinra.
Methods:
We analyzed the systemic inflammation and composite end-point of new-onset HF or death in women and men with STEMI treated with anakinra from three different Virginia Commonwealth University Anakinra Response Trial (VCUART) randomized clinical trials.
Results:
We analyzed 139 patients, 29 (21%) were women while 110 (79%) were men. Baseline hsCRP was higher in women compared to men (8.9 [5.2-13.5] vs. 4.2 [2.1-7.7] mg/L, P<0.001). Eighty-four patients were treated with anakinra (22 [75%] women and 62 [56%] men). The area under the curve of hsCRP (hsCRP-AUC) after 14 days was numerically lower in patients receiving anakinra versus placebo both in men (86 [37-130] vs. 223 [119-374] mg day/L) and in women (73 [46-313] vs. 242 [102-988] mg day/L) (P<0.001 for multiple groups, P for interaction 0.22). The incidence of the composite endpoint was also numerically lower in the anakinra group compared to placebo, both in men (4 [6.4%] vs. 14 [29.1%]) and in women (3 [13.6%] vs. 2 [28.5%]) (P=0.019 for multiple groups, P for interaction 0.44). There were no statistically significant differences between women and men in hsCRP-AUC and death or HF events when comparing separately the anakinra and placebo groups (all P>0.05).
Conclusions:
Women were underrepresented in the VCUART trials, they appeared to have higher hsCRP levels at time of presentation, yet to benefit similar to men by treatment with anakinra in STEMI.
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