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Infliximab infusion may increase risk of ventricular arrhythmias in patients with RA, data suggest

Friday, August 29 2008 | Comments

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What's This? Acute infusion of infliximab may increase the risk of certain arrhythmias, especially in patients with rheumatoid arthritis, study findings indicate.

Data from recent studies have suggested that treatment with infliximab may be associated with potentially life-threatening cardiac rhythm disorders and the progression of left ventricular dysfunction in patients with chronic heart failure, the authors of the study noted.

To evaluate the prevalence of cardiac rhythm disorders during acute infusion of infliximab, researchers conducted a prospective, single-blind, crossover study that included 75 consecutive patients with spondyloarthritis (n=55) or RA (n=20) who had no history of coronary artery disease or other cardiac abnormalities.

The participants received a loading dose of infliximab (3 mg/kg to 5 mg/kg) at baseline and at weeks 2 and 6, followed by scheduled maintenance treatments 8 weeks apart. The crossover design called for all of the patients to receive intravenous saline in the absence (ie, placebo) or in the presence of infliximab during a 2-hour period for each infusion; accordingly, the placebo infusion took place before infliximab administration in 38 patients and afterward in 37 patients.

The occurrence of both tachyarrhythmias and bradyarrhythmias was numerically but not statistically significantly greater during infliximab infusion than during placebo.

New-onset ventricular tachyarrhythmias occurred in 8.0% of the patients during the infusion of infliximab, compared with 2.7% of the patients during placebo infusions (OR, 3.17; 95% CI, 0.61-16.26; P=.27), and these events were more severe during the infliximab infusions relative to the placebo infusions, the authors noted.

The patients who experienced the ventricular tachyarrhythmias had significantly longer baseline-corrected QT (QTc) intervals (432.3 vs 407.3; P=.01) and a higher prevalence of QTc prolongation as compared with the patients who did not experience these arrhythmias. Further, all heart rate variability measures assessed in the frequency domain were significantly lower in the patients with these arrhythmias relative to those without.

The presence of RA also appeared to predict reactions to infliximab, whereby new-onset ventricular arrhythmias developed in 20% of the patients with RA and in 3.6% of the patients with spondyloarthritis. Overall, the patients with RA had longer mean QTc intervals, higher prevalences of QTc prolongation, and reduced heart rate variability measures in the frequency domain relative to the patients with spondyloarthritis.

"For practical clinical application, our results suggest that a brief electrocardiogram recording (5-10 min) to obtain a frequency-domain heart rate variability analysis and QTc interval measurement in eligible patients (particularly those with RA) before the onset of infliximab therapy may identify the patient subgroup with a relatively higher risk of developing tachyarrhythmias during infusion of the drug," the authors concluded.

These findings were published online Aug. 15 ahead of print in the Journal of Rheumatology by Lazzerini PE, et al.

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