Effects of pentoxyfylline in patients with idiopathic dilated cardiomyopathy: a meta-analysis

1. Effects of pentoxyfylline in patients with idiopathic dilated cardiomyopathy:a meta-analysis Adelina S. Paule, MD1 and Fatima D. Collado, MD2 1Cardiology Fellow-in-Training, Heart Institute 2Vascular Consultant, Heart Institute St. Luke’s Medical Center, Quezon City

2. Idiopathic Dilated Cardiomyopathy (IDC) Primary myocardial disease of unknown cause characterized by left ventricular or biventricular dilatation and impaired myocardial contractility.

3. Idiopathic Dilated Cardiomyopathy

4. Heart Failure

5. Heart Failure European Journal of Heart FailureVolume 11, Issue 2Pp. 113-118 February 2009 Immunological mechanisms of pentoxifylline in chronic heart failure)

6. Pentoxifylline European Journal of Heart FailureVolume 11, Issue 2Pp. 113-118 February 2009 Immunological mechanisms of pentoxifylline in chronic heart failure)

7. Research Question Among patients with idiopathic dilated cardiomyopathy, does Pentoxyfylline improves left ventricular performance ?

8. Objective Determine if Pentoxyfylline can improve left ventricular performance among patients with idiopathic dilated cardiomyopathy

9. Inclusion Criteria • Types of Participants:  • age >18 and<70 years • NYHA functional class II to IV with or without signs and symptoms of heart failure of unknown cause • left ventricular ejection fraction (LVEF) 40% by radionuclide angiography • left ventricular end-diastolic diameter 55 mm • sinus rhythm • received intravenous dobutamine (3 to 5 ug/kg/min) for at least the first 72 hours • eligible patients in whom high-quality echocardiographic images could be obtained.

10. Exclusion Criteria • Types of Participants:  • coronary artery disease • chronic obstructive pulmonary disease • significant valvular heart disease • history or evidence of ischemic heart disease • systolic blood pressure 160 mm Hg and/or diastolic blood pressure 95 mm Hg • clinical conditions other than cardiomyopathy that could increase cytokine levels (eg, rheumatoid arthritis, sepsis) • pregnancy • severe liver disease • defined as enzymes 2 times the upper limit of normal

11. Methodology Potentially eligible reports identified and retrieved (n = 4) Reports included (n = 4)

12. Included Studies

13. Included Studies

14. Results Forest plot of comparison: 1 Effects of Pentoxyfylline, outcome: 1.1 Improvement of left ventricular function

15. Results Funnel plot of comparison: 1 Effects of Pentoxyfylline, outcome: 1.1 Improvement of left ventricular function

16. Results Forest plot of comparison: 1 Effects of Pentoxyfylline, outcome: 1.1 Improvement of left ventricular function

17. Conclusion Pentoxyfylline did not show statistically significant effect in improving left ventricular performance among patients with idiopathic dilated cardiomyopathy.

18. Conclusion Current Cost of treatment: 132.00 Pentoxyfylline 400mg/tab TID = 90.00

19. Thank you

20. Results The European Journal of Heart Failure 6 (2004) 195–201  Pentoxifylline in ischemic, hypertensive and idiopathic-dilated cardiomyopathy: effects on left-ventricular function, inflammatory cytokines and symptoms Philipp Bahrmann*, Uta M. Hengst, Babara M. Richartz, Hans R. Figulla Clinic of Internal Medicine I, Friedrich-Schiller-University, Erlanger Allee 101, 07740 Jena, GermanyReceived 1 November 2002; received in revised form 16 May 2003; accepted 15 September 2003 Abstract Introduction: Tumor necrosis factor (TNF)-a and interleukin-6 (IL-6) are significantly elevated in patients with congestive heart failure (CHF). Pentoxifylline, a xanthin-derived agent, is known to inhibit the production of TNF-a and IL-6. Recent studies have shown that pentoxifylline produces an increase in ejection fraction, a decrease in left-ventricular chamber size and an improvement in clinical status in patients with idiopathic-dilated cardiomyopathy. Therefore, we studied the effects of pentoxifylline in ischemic, hypertensive and idiopathic-dilated cardiomyopathy. Methods: Primary endpoint was left-ventricular ejection fraction (LVEF) assessed by contrast 2D echocardiography. Secondary endpoints were concentrations of TNF-a, IL-6, brain natriuretic peptide, maximal oxygen uptake (VO2 max) assessed by cardiopulmonary exercise testing and Minnesota Living with Heart Failure Questionnaire score or New York Heart Association scale. Results: Forty-seven patients (31.9% ischemic, 21.3% hypertensive, 10.6% ischemic and hypertensive, 36.2% idiopathic-dilated cardiomyopathy) were randomly assigned to pentoxifylline 600 mg BID (ns23) or placebo (ns24) if they had a compensated CHF with a LVEF less than or equal to 40% and had taken their standard treatment consisting of angiotensin-converting enzyme inhibitors, diuretics and b-blockers for at least 3 months. Baseline demographic and clinical characteristics of each group were similar. Forty-one patients completed the study protocol and were analysed for primary and secondary endpoints. After 6 months of treatment, LVEF was unchanged in the pentoxifylline group compared with placebo (29"7 to 33"10% vs. 27"9 to 34"9%, respectively, PsNS). Also the secondary endpoints did not significantly change during follow-up. Conclusion: Additional treatment with pentoxifylline is neutral with regard to left-ventricular function, inflammatory cytokines and symptoms in patients with ischemic, hypertensive and idiopathic-dilated cardiomyopathy.􏰒 2003 European Society of Cardiology. Published by Elsevier B.V. All rights reserved. Keywords: Cardiomyopathy; Heart failure treatment; Ejection fraction; Cytokines; Pentoxifylline Funnel plot of comparison: 1 Effects of Pentoxyfylline, outcome: 1.1 Improvement of left ventricular function