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Meta-Analysis
. 2025 May;30(3):575-587.
doi: 10.1007/s10741-025-10491-5. Epub 2025 Feb 12.

Effects of anti-inflammatory therapy in acute heart failure: a systematic review and meta-analysis

Beth A Davison  1   2   3 , Antonio Abbate  4 , Gad Cotter  5   6   7 , Domingo Pascual-Figal  8   9   10 , Benjamin Van Tassell  11 , Julio Núñez Villota  10   12 , Lina Atabaeva  7 , Yonathan Freund  13   14 , Alberto Aimo  15 , Jan Biegus  16 , Michele Golino  11 , Marco Giuseppe Del Buono  11 , Ovidiu Chioncel  17 , Alain Cohen-Solal  5   18 , Christopher Edwards  7 , Noelia Fernández-Villa  8 , Gerasimos Filippatos  19 , José Ramón González-Juanatey  10   20 , Hamlet Hayrapetyan  21 , Borja Ibáñez  9   10   22 , Pau Llàcer Iborra  23 , Francesco Moroni  4 , Jozine M Ter Maaten  24 , Roshanak Markley  11 , Javier González-Martín  10   25 , Manuel Martínez-Sellés  26 , Mayranush Drambyan  27 , Marco Metra  28 , Sonia Mirabet  10   29 , Andranik Mshetsyan  30 , Maria Novosadova  7 , Matteo Pagnesi  28 , Piotr Ponikowski  16 , Alejandro Riquelme-Pérez  8 , Malha Sadoune  5 , Manuel Anguita Sánchez  31 , Tabassome Simon  13   32 , Mikel Taibo-Urquía  10   22 , Koji Takagi  7 , Sandra Villar  10   12 , Chao Liu  33 , Adriaan A Voors  24 , Alexandre Mebazaa  5   34 , Douglas L Mann  35 , Antoni Bayés-Genís  10   36
Affiliations
Meta-Analysis

Effects of anti-inflammatory therapy in acute heart failure: a systematic review and meta-analysis

Beth A Davison et al. Heart Fail Rev. 2025 May.

Abstract

We examined current evidence regarding the effects of anti-inflammatory therapies in patients with acute heart failure (AHF) on the risk of cardiovascular outcomes, inflammatory markers, natriuretic peptides, and renal function. Despite growing evidence that inflammation plays a pivotal role in both the development and progression of heart failure, including AHF, only a few trials have been conducted to date in patients with AHF. A systematic literature search of PubMed, Medline, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov was conducted in November 2024 to identify randomized controlled trials (RCTs) evaluating anti-inflammatory therapies in adult patients with AHF. Meta-analyses were conducted to estimate effects on clinical outcomes (death, HF readmission, or worsening HF) and inflammatory and other markers. Five RCTs were identified that enrolled a total of 289 patients to an anti-inflammatory intervention and 273 to a control. Prednisone was examined in two RCTs, anakinra in two, and colchicine in one. Three of the five trials required elevated C-reactive protein (CRP) level for entry. Anti-inflammatory therapy was associated with a reduced risk of the composite outcome (hazard ratio 0.55 [95% CI 0.35-0.86]) and an overall 54% greater reduction in CRP to end of therapy (ratio of geometric mean ratios 0.46 [95% CI 0.29-0.73]), which varied across studies. NT-proBNP and creatinine were not significantly affected. The analysis is limited by the small number of studies but suggests that anti-inflammatory therapy reduces inflammation and may reduce the risk of adverse clinical outcomes in patients with AHF.

Keywords: Acute heart failure; Anti-inflammatory agents; Inflammation; Prognosis.

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Conflict of interest statement

Declarations. Competing interests: BAD, GC, LA, CE, MN, and KT are employees of Momentum Research, which has received grants for research from the Heart Initiative, Corteria, Windtree, Echosens, and 4teen4. AA has served as a consultant to Kiniksa, MonterosaRx, and Novo Nordisk. DPF has received consultancy and speaker fees and lectures from AstraZeneca, Novartis, Roche Diagnostics, Pfizer, Vifor, Rovi, Bayer. JNV has received consultancy and speaker fees and lectures from AstraZeneca, Alleviant, Amgen, Bayer, Boehringer Ingelheim, CSL Vifor, Daiichi Sankyo, GSK, Lilly, Pfizer, Novartis, NovoNordisk, and Rovi. JB has received honoraria from Bayer, Boehringer Ingelheim, and AstraZeneca, Alleviant Medical and WhiteSwell. OC has received grants from Servier. ACS has received honoraria for lectures or consultancy from AstraZeneca, Novartis, Vifor, Bayer, Merck, Sanofi, Abbott, and Boehringer Ingelheim. GF has received lecture fees or was a committee member for trials and registries sponsored by Bayer, Vifor, Boehringer Ingelheim, Medtronic, Servier, and Amgen. JMTM reports speaker and/or consultancy fees to institution from Novartis, Boehringer Ingelheim, Moderna, Roche, and Novo Nordisk, and receiving grants from Netherlands Heart Foundation, and Netherlands Organization for Scientific Research (NWO) outside the submitted work. MM received consulting honoraria from Abbott Structural, Astra-Zeneca, Bayer, Boehringer Ingelheim, Edwards LifeSciences, NovoNordisk, Richie Diagnostics in the last three years. MP has received personal fees from Abbott Vascular, AstraZeneca, Boehringer Ingelheim, Novartis, Roche Diagnostics and Vifor Pharma. The employer of AAV received consultancy fees and/or research support from Adrenomed, Anacardio, AstraZeneca, Bayer AG, BMS, Boehringer Ingelheim, Corteria, EliLilly, Merck, Moderna, Novartis, Novo Nordisk, Roche diagnostics, SalubrisBio. AM has received grants from Roche Diagnostics, Abbott Laboratories, 4TEEN4, and Windtree Therapeutics; honoraria for lectures from Roche Diagnostics, Bayer, and MSD; is a consultant for Corteria Pharmaceuticals, S-form Pharma, FIRE-1, Implicity, 4TEEN4, and Adrenomed; and is coinventor of a patent on combination therapy for patients having acute or persistent dyspnoea. DLM is on the scientific advisory board for Tenaya Therapeutics, HAYA Therapeutics, Cardurion Therapeutics and is a consultant from Novo holdings and Tourmaline Therapeutics. ABG has participated in advisory boards and/or lectured for Abbott, AstraZeneca, Bayer, Boehringer Ingelheim, Novartis, Roche Diagnostics, Vifor. All other authors have nothing to disclose. CL has nothing to disclose.

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