Effects of anakinra on patients with heart failure below and above 60 years of age

Abstract Background Anakinra, an interleukin-1 (IL-1) blocker, is being explored in heart failure (HF) to improve cardiorespiratory fitness (CRF). CRF declines with increasing age. Purpose We aimed to determine the influence of anakinra on CRF in aging patients with HF. Methods We analyzed data from 73 patients with HF (55 [51-62] years, 37 (51%) female) treated with anakinra 100 mg subcutaneously daily. Patients were stratified into two groups according to a predetermined cut-off age of 60 years. We measured peak oxygen consumption (peak VO2) and C-reactive protein (CRP), a surrogate for IL-1 activity. Results We included 49 (67%) patients with age <60 years and 24 (33%) with age ≥60 years. The duration of treatment with anakinra was 4 [2-12] weeks. Age was negatively correlated with peak VO2 at baseline and during treatment with anakinra (Spearman’s Rho= -0.375, p=0.001 and Rho= -0.334, p=0.004, respectively). Younger patients had higher baseline peak VO2 (15.2 [12.4–17.7] vs 12.4 [10.3–14.3] mLO2·kg-1·min-1, p=0.001) but similar CRP (6.6 [3.6-16.6] vs 5.1 [2.7-11.2] mg/L, p=0.18). In both groups, anakinra decreased CRP (<60 years: from 6.6 [3.6–16.6] to 1.5 [0.9–3.8] mg/L, p<0.001; ≥60 years: from 5.1 [2.7–11.2] to 1.0 [0.5–3.4] mg/L, p<0.001)(Figure 1A) and increased peak VO2 (<60 years: from 15.2 [12.4–17.7] to 16.0 [14.0–18.7] mLO2·kg-1·min-1, p=0.036; ≥60 years: from 12.4 [10.3–14.3] to 13.7 [11.7–15.8] mLO2·kg-1·min-1, p<0.001)(Figure 1B). No significant differences in interval changes were observed between the groups. Conclusions Older patients with HF have a greater impairment in CRF than younger patients, yet they appear to benefit similarly from treatment with anakinra.Figure 1