Heart Under Pressure: Divergent Cardiac Molecules Responses to Azathioprine and Anti-TNF Therapy in Ulcerative Colitis

The treatment of moderate-to-severe ulcerative colitis often requires escalation from 5-ASA therapy to immunosuppressants or biologic agents. However, the effects of azathioprine and anti-TNF therapies on cardiac status and associated biomolecules remain insufficiently studied. In this prospective observational study, we included 84 patients with moderate-to-severe ulcerative colitis, divided into three treatment groups based on the therapy received (azathioprine, infliximab, or adalimumab), along with 25 healthy controls. Levels of proBNP, NT-proBNP, creatine kinase (CK), CK-MB, and high-sensitivity troponin I (hsTnI) were measured at baseline, 6 h after treatment initiation, and after 3 months of therapy. Troponin levels did not significantly change across the three time points in any treatment group. In contrast, levels of proBNP, NT-proBNP, CK, and CK-MB significantly decreased after 3 months in patients treated with biologics, whereas a significant increase was observed in the azathioprine group. Further prospective trials are needed to adequately assess the cardiac safety of these therapies, particularly in patients with preexisting cardiac impairment.