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Circulation. 2004;109:1594-1602
Published online before print March 15, 2004, doi: 10.1161/01.CIR.0000124490.27666.B2
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(Circulation. 2004;109:1594-1602.)
© 2004 American Heart Association, Inc.


Clinical Investigation and Reports

Targeted Anticytokine Therapy in Patients With Chronic Heart Failure

Results of the Randomized Etanercept Worldwide Evaluation (RENEWAL)

Douglas L. Mann, MD; John J.V. McMurray, MD, FRCP, FESC; Milton Packer, MD; Karl Swedberg, MD, PhD, FESC; Jeffrey S. Borer, MD; Wilson S. Colucci, MD; Jacques Djian, MD, FESC; Helmut Drexler, MD; Arthur Feldman, MD, PhD; Lars Kober, MD; Henry Krum, MD, PhD, FRACP; Peter Liu, MD; Markku Nieminen, MD, PhD; Luigi Tavazzi, MD; Dirk Jan van Veldhuisen, MD, PhD; Anders Waldenstrom, MD, PhD; Marshelle Warren, MD; Arne Westheim, MD; Faiez Zannad, MD, PhD; Thomas Fleming, PhD

From the Winters Center for Heart Failure Research (D.L.M.), Baylor College of Medicine and the Houston VA, Houston, Tex; Department of Cardiology, Western Infirmary (J.J.V.M.), Glasgow, United Kingdom; Department of Medicine, University of Texas Dallas Southwestern Medical Center (M.P.), Dallas, Tex; Department of Medicine, Sahlgrenska University Hospital/Östra (K.S.), Göteborg, Sweden; Division of Cardiovascular Pathophysiology, Weill Medical College of Cornell University (J.S.B.), New York, NY; Division of Cardiology, Boston Medical Center (W.S.C.), Boston, Mass; Wyeth Research (J.D.), Paris, France; Medizinische Hochschule (H.D.), Hannover, Germany; Division of Cardiology, University of Pittsburgh Medical Center (A.F.), Pittsburgh, Pa; Gentofte Hospital/University of Copenhagen (L.K.), Department of Cardiology, Niels Andersens Vej, Denmark; Clinical Pharmacology Unit, Alfred Hospital (H.K.), Prahran, Victoria, Australia; The Toronto Hospital (P.L.), Cardiology Research, Toronto, Ontario, Canada; Division of Cardiology, Helsinki University Central Hospital (M.N.), Haartmaninkatu, Helsinki, Finland; Divisione di Cardiologia, Policlinico San Matteo-IRCCS (L.T.), Pavia, Italy; Academisch Ziekenhuis Groningen (D.J.v.V.), Cardio Research, GZ Groningen, The Netherlands; Department of Medicine, Umea University Hospital (A.W.), Umea, Sweden; Amgen Inc (M.W.), Thousand Oaks, Calif; Medicinsk Klinikk (A.W.), Hjertemedisinsk Avd, Ullevål Sykehus, Oslo, Norway; Centre d’Investigation Clinique (F.Z.), Hopital Jeanne d’Arc, Dommartin Les Toul Cedex, France; and Department of Biostatistics (T.F.), University of Washington, Seattle, Wash.

Correspondence to Douglas L Mann, MD, Winters Center for Heart Failure Research, MS 524, 6565 Fannin, Houston, TX 77030. E-mail dmann{at}bcm.tmc.edu

Received December 20, 2003; revision received January 26, 2004; accepted January 26, 2004.

Background— Studies in experimental models and preliminary clinical experience suggested a possible therapeutic role for the soluble tumor necrosis factor antagonist etanercept in heart failure.

Methods and Results— Patients with New York Heart Association class II to IV chronic heart failure and a left ventricular ejection fraction <=0.30 were enrolled in 2 clinical trials that differed only in the doses of etanercept used. In RECOVER, patients received placebo (n=373) or subcutaneous etanercept in doses of 25 mg every week (n=375) or 25 mg twice per week (n=375). In RENAISSANCE, patients received placebo (n=309), etanercept 25 mg twice per week (n=308), or etanercept 25 mg 3 times per week (n=308). The primary end point of each individual trial was clinical status at 24 weeks. Analysis of the effect of the 2 higher doses of etanercept on the combined outcome of death or hospitalization due to chronic heart failure from the 2 studies was also planned (RENEWAL). On the basis of prespecified stopping rules, both trials were terminated prematurely owing to lack of benefit. Etanercept had no effect on clinical status in RENAISSANCE (P=0.17) or RECOVER (P=0.34) and had no effect on the death or chronic heart failure hospitalization end point in RENEWAL (etanercept to placebo relative risk=1.1, 95% CI 0.91 to 1.33, P=0.33).

Conclusions— The results of RENEWAL rule out a clinically relevant benefit of etanercept on the rate of death or hospitalization due to chronic heart failure.


Key Words: heart failure • tumor necrosis factor • etanercept • cytokines




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Rheumatology (Oxford)Home page
F. C. Hall and N. Dalbeth
Disease modification and cardiovascular risk reduction: two sides of the same coin?
Rheumatology, December 1, 2005; 44(12): 1473 - 1482.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
E. A. Jankowska, S. von Haehling, A. Czarny, E. Zaczynska, A. Kus, S. D. Anker, W. Banasiak, and P. Ponikowski
Activation of the NF-{kappa}B system in peripheral blood leukocytes from patients with chronic heart failure
Eur J Heart Fail, October 1, 2005; 7(6): 984 - 990.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
S. Grundmann, I. Hoefer, S. Ulusans, N. van Royen, S. H. Schirmer, C. K. Ozaki, C. Bode, J. J. Piek, and I. Buschmann
Anti-tumor necrosis factor-{alpha} therapies attenuate adaptive arteriogenesis in the rabbit
Am J Physiol Heart Circ Physiol, October 1, 2005; 289(4): H1497 - H1505.
[Abstract] [Full Text] [PDF]


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CirculationHome page
A. L. Clark and J. G.F. Cleland
Anemia and Chronic Heart Failure: Are We Asking the Right Questions?
Circulation, September 20, 2005; 112(12): 1681 - 1683.
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LupusHome page
P Sarzi-Puttini, F Atzeni, A Doria, L Iaccarino, and M Turiel
Tumor necrosis factor-a, biologic agents and cardiovascular risk
Lupus, September 1, 2005; 14(9): 780 - 784.
[Abstract] [PDF]


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Circ. Res.Home page
Z. Kassiri, G. Y. Oudit, O. Sanchez, F. Dawood, F. F. Mohammed, R. K. Nuttall, D. R. Edwards, P. P. Liu, P. H. Backx, and R. Khokha
Combination of Tumor Necrosis Factor-{alpha} Ablation and Matrix Metalloproteinase Inhibition Prevents Heart Failure After Pressure Overload in Tissue Inhibitor of Metalloproteinase-3 Knock-Out Mice
Circ. Res., August 19, 2005; 97(4): 380 - 390.
[Abstract] [Full Text] [PDF]


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CirculationHome page
D. Mancini and D. Burkhoff
Mechanical Device-Based Methods of Managing and Treating Heart Failure
Circulation, July 19, 2005; 112(3): 438 - 448.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
D. Gurantz, A. Yndestad, B. Halvorsen, O. V. Lunde, J. H. Omens, T. Ueland, P. Aukrust, C. D. Moore, J. Kjekshus, and B. H. Greenberg
Etanercept or intravenous immunoglobulin attenuates expression of genes involved in post-myocardial infarction remodeling
Cardiovasc Res, July 1, 2005; 67(1): 106 - 115.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
D. Burkhoff and S. A. Ben-Haim
Nonexcitatory electrical signals for enhancing ventricular contractility: rationale and initial investigations of an experimental treatment for heart failure
Am J Physiol Heart Circ Physiol, June 1, 2005; 288(6): H2550 - H2556.
[Full Text] [PDF]


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J Am Coll CardiolHome page
E. P. Havranek
Improving the Outcomes of Heart Failure Care: Putting Technology Second
J. Am. Coll. Cardiol., May 17, 2005; 45(10): 1665 - 1666.
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Physiol. GenomicsHome page
M. M. Kittleson, K. M. Minhas, R. A. Irizarry, S. Q. Ye, G. Edness, E. Breton, J. V. Conte, G. Tomaselli, J. G. N. Garcia, and J. M. Hare
Gene expression analysis of ischemic and nonischemic cardiomyopathy: shared and distinct genes in the development of heart failure
Physiol Genomics, May 11, 2005; 21(3): 299 - 307.
[Abstract] [Full Text] [PDF]


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Ann Rheum DisHome page
P J Mease and C E Antoni
Psoriatic arthritis treatment: biological response modifiers
Ann Rheum Dis, March 1, 2005; 64(suppl_2): ii78 - ii82.
[Abstract] [Full Text] [PDF]


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ANN INTERN MEDHome page
A. T. Yan, R. T. Yan, and P. P. Liu
Narrative Review: Pharmacotherapy for Chronic Heart Failure: Evidence from Recent Clinical Trials
Ann Intern Med, January 18, 2005; 142(2): 132 - 145.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
S. Lecour, L. Rochette, and L. Opie
Free radicals trigger TNF{alpha}-induced cardioprotection
Cardiovasc Res, January 1, 2005; 65(1): 239 - 243.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
J. J.V. McMurray and M. A. Pfeffer
The year in heart failure
J. Am. Coll. Cardiol., December 21, 2004; 44(12): 2398 - 2405.
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CirculationHome page
M. Sun, F. Dawood, W.-H. Wen, M. Chen, I. Dixon, L. A. Kirshenbaum, and P. P. Liu
Excessive Tumor Necrosis Factor Activation After Infarction Contributes to Susceptibility of Myocardial Rupture and Left Ventricular Dysfunction
Circulation, November 16, 2004; 110(20): 3221 - 3228.
[Abstract] [Full Text] [PDF]


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CirculationHome page
U. C. Sharma, S. Pokharel, T. J. van Brakel, J. H. van Berlo, J. P.M. Cleutjens, B. Schroen, S. Andre, H. J.G.M. Crijns, H.-J. Gabius, J. Maessen, et al.
Galectin-3 Marks Activated Macrophages in Failure-Prone Hypertrophied Hearts and Contributes to Cardiac Dysfunction
Circulation, November 9, 2004; 110(19): 3121 - 3128.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
G. Torre-Amione, F. Sestier, B. Radovancevic, and J. Young
Effects of a novel immune modulation therapy in patients with advanced chronic heart failure: Results of a randomized, controlled, phase II trial
J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1181 - 1186.
[Abstract] [Full Text] [PDF]


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Evid. Based Med.Home page
Other articles noted
Evid. Based Med., September 1, 2004; 9(5): e5 - e5.
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