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Eur Heart J. 2015 Feb 7;36(6):377-84. doi: 10.1093/eurheartj/ehu272. Epub 2014 Jul 30.

The effect of interleukin-1 receptor antagonist therapy on markers of inflammation in non-ST elevation acute coronary syndromes: the MRC-ILA Heart Study.

Author information

1
Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
2
Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK Department of Cardiovascular Science, University of Sheffield, Sheffield, UK.
3
Academic Unit of Cardiovascular Medicine, Yorkshire Heart Centre, Leeds, UK.
4
Abertawe Bro Morgannwg University NHS Trust, Morriston Hospital, Swansea, UK.
5
Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK.
6
Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK.
7
Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK.
8
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
9
Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
10
School of Medicine, University of St Andrews, KY16 9TF, UK dcc7@st-andrews.ac.uk.

Abstract

AIMS:

Acute coronary syndromes (ACSs) are driven by inflammation within coronary plaque. Interleukin-1 (IL-1) has an established role in atherogenesis and the vessel-response to injury. ACS patients have raised serum markers of inflammation. We hypothesized that if IL-1 is a driving influence of inflammation in non-ST elevation ACS (NSTE-ACS), IL-1 inhibition would reduce the inflammatory response at the time of ACS.

METHODS AND RESULTS:

A phase II, double-blinded, randomized, placebo-controlled, study recruited 182 patients with NSTE-ACS, presenting <48 h from onset of chest pain. Treatment was 1:1 allocation to daily, subcutaneous IL-1receptor antagonist (IL-1ra) or placebo for 14 days. Baseline characteristics were well matched. Treatment compliance was 85% at 7 days. The primary endpoint (area-under-the-curve for C-reactive protein over the first 7 days) was: IL-1ra group, 21.98 mg day/L (95%CI 16.31-29.64); placebo group, 43.5 mg day/L (31.15-60.75) (geometric mean ratio = 0.51 mg/L; 95%CI 0.32-0.79; P = 0.0028). In the IL-1ra group, 14-day achieved high-sensitive C-reactive protein (P < 0.0001) and IL-6 levels (P = 0.02) were lower than Day 1. Sixteen days after discontinuation of treatment (Day 30) high-sensitive C-reactive protein levels had risen again in the IL-1ra group [IL-1ra; 3.50 mg/L (2.65-4.62): placebo; 2.21 mg/L (1.67-2.92), P = 0.022]. MACE at Day 30 and 3 months was similar but at 1 year there was a significant excess of events in the IL-1ra group.

CONCLUSION:

IL-1 drives C-reactive protein elevation at the time of NSTE-ACS. Following 14 days IL-1ra treatment inflammatory markers were reduced. These results show the importance of IL-1 as a target in ACS, but also indicate the need for additional studies with anti-IL-1 therapy in ACS to assess duration and safety.

CLINICAL TRIAL REGISTRATION EUCTR:

2006-001767-31-GB: www.clinicaltrialsregister.eu/ctr-search/trial/2006-001767-31/GB.

KEYWORDS:

Drugs; Interleukins; Myocardial infarction

PMID:
25079365
PMCID:
PMC4320321
DOI:
10.1093/eurheartj/ehu272
[Indexed for MEDLINE]
Free PMC Article

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