What are the cardiac effects of Adalimumab (Humira)?

From the Guidelines

Humira (adalimumab) is generally considered safe in terms of cardiac effects for most patients, but it should be used with caution in patients with pre-existing heart failure, particularly those with higher NYHA functional classes (III-IV) 1.

Key Considerations

• Humira works by blocking tumor necrosis factor-alpha (TNF-α), which reduces inflammation in conditions like rheumatoid arthritis, psoriasis, and inflammatory bowel disease.
• Some studies suggest that TNF inhibitors like Humira might provide cardiovascular benefits in certain inflammatory conditions by reducing systemic inflammation that contributes to atherosclerosis.
• Patients with pre-existing heart failure should use Humira cautiously, as it may potentially worsen their condition.
• Patients should report any new or worsening symptoms such as shortness of breath, sudden weight gain, or swelling to their healthcare provider immediately.

Important Precautions

• Before starting Humira, patients should inform their doctor about any history of heart problems.
• Regular monitoring may be recommended for those with cardiovascular risk factors.
• The cardiovascular safety profile of Humira is generally favorable compared to some other anti-inflammatory medications, particularly NSAIDs, which have more established cardiac risks.

Recommendations

• Patients with rheumatoid arthritis or other conditions treated with Humira should be closely monitored for any signs of cardiac complications.
• Healthcare providers should weigh the benefits and risks of Humira in patients with pre-existing heart conditions and consider alternative treatments if necessary.
• Further research is needed to fully understand the cardiac effects of Humira and other TNF inhibitors, but current evidence suggests that they are generally safe for most patients 1.

From the FDA Drug Label

New heart failure or worsening of heart failure you already have Call your doctor right away if you get new worsening symptoms of heart failure while taking HUMIRA, including: shortness of breath sudden weight gain swelling of your ankles or feet Cardiac Effects of Humira:

• Humira may cause new heart failure or worsening of existing heart failure.
• Symptoms to watch out for include:
  • Shortness of breath
  • Sudden weight gain
  • Swelling of the ankles or feet If you experience any of these symptoms, call your doctor right away 2.

From the Research

Humira Cardiac Effects

• Humira (adalimumab) has been associated with rare but serious cardiac side effects, including:
  • Worsening or initiation of congestive heart failure 3, 4
  • Acute pleuropericarditis 5
• The use of TNF-alpha blockers, such as adalimumab, in patients with heart failure is controversial, with some studies suggesting that they may have untoward effects in the setting of heart failure 6
• The effects of TNF-alpha blockers on incident cases of congestive heart failure in rheumatoid arthritis patients are unclear, but it is recommended that patients with well-compensated mild heart failure be closely monitored for any clinical signs of worsening heart failure 6
• There is no direct evidence to suggest that adalimumab is a cause of cardiac amyloidosis, but the condition is a separate entity that requires different treatment approaches 7
• The cardiac side effects of adalimumab can be life-threatening, and it is essential to recognize the potential risks and monitor patients closely 4, 5