A Preliminary Study of Anti‐TNFα Therapy for Symptomatic Dolichoectatic Vertebrobasilar Aneurysms
Background Dolichoectatic vertebrobasilar aneurysms (DVBAs) carry high morbidity, and treatment options are limited. The tumor necrosis factor α signaling cascade is implicated in DVBA growth and rupture, but the role of anti–tumor necrosis factor α therapy in DVBA has not been studied. Methods A re...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-01-01
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| Series: | Stroke: Vascular and Interventional Neurology |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.123.000890 |
| _version_ | 1827356956926410752 |
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| author | Michael Travis Caton Kazim Narsinh Woody Han Ramani Chaganti Jonathan Graf Cathra Halabi Ethan Winkler Daniel L. Cooke |
| author_facet | Michael Travis Caton Kazim Narsinh Woody Han Ramani Chaganti Jonathan Graf Cathra Halabi Ethan Winkler Daniel L. Cooke |
| author_sort | Michael Travis Caton |
| collection | DOAJ |
| description | Background Dolichoectatic vertebrobasilar aneurysms (DVBAs) carry high morbidity, and treatment options are limited. The tumor necrosis factor α signaling cascade is implicated in DVBA growth and rupture, but the role of anti–tumor necrosis factor α therapy in DVBA has not been studied. Methods A retrospective, case–control study of DVBA at a single institution was performed. Two patients with DVBA were treated with infliximab (tumor necrosis factor α inhibitor) as part of routine therapy for rheumatoid arthritis. Three additional patients diagnosed with DVBA were studied as a control group. Routine brain magnetic resonance imaging/magnetic resonance angiography were measured by 2 blinded neuroradiologists to assess DVBA growth. Baseline comorbidities and clinical outcomes were assessed by chart review. Results The groups were similar with respect to baseline characteristics, and all patients were symptomatic at the time of DVBA diagnosis. One patient who started infliximab during the study period showed a reversal in DVBA growth rate trajectory, with a relative decrease in growth rate by 37% (0.49–0.18 mm2/day). Mean interval DVBA growth rates were lower during infliximab therapy than during noninfliximab observation intervals (0.13 versus 0.50 mm2/day; P = 0.09). Two patients in the control group died during the study period and 1 had a poor outcome (modified Rankin scale = 4). Both patients in the infliximab group had unchanged functional status (modified Rankin scale = 1) and no adverse events related to infliximab. Conclusion This study presents the first investigation of anti–tumor necrosis factor α therapy for DVBA. Infliximab was associated with low and decreasing DVBA growth trajectories with no treatment‐related adverse events. The effect of infliximab on clinical outcomes remains uncertain. |
| first_indexed | 2024-03-08T05:17:23Z |
| format | Article |
| id | doaj.art-b73a9dc294da4cc08a04b60bca6d09cb |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-03-08T05:17:23Z |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-b73a9dc294da4cc08a04b60bca6d09cb2024-02-06T17:23:07ZengWileyStroke: Vascular and Interventional Neurology2694-57462024-01-014110.1161/SVIN.123.000890A Preliminary Study of Anti‐TNFα Therapy for Symptomatic Dolichoectatic Vertebrobasilar AneurysmsMichael Travis Caton0Kazim Narsinh1Woody Han2Ramani Chaganti3Jonathan Graf4Cathra Halabi5Ethan Winkler6Daniel L. Cooke7Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York NYDepartment of Radiology and Biomedical Imaging Neurointerventional Section University of California San Francisco CADepartment of Radiology and Biomedical Imaging Neurointerventional Section University of California San Francisco CADepartment of Rheumatology University of California San Francisco CADepartment of Rheumatology University of California San Francisco CADepartment of Neurology University of California San Francisco CADepartment of Neurosurgery Barrow Neurological Institute AZDepartment of Radiology and Biomedical Imaging Neurointerventional Section University of California San Francisco CABackground Dolichoectatic vertebrobasilar aneurysms (DVBAs) carry high morbidity, and treatment options are limited. The tumor necrosis factor α signaling cascade is implicated in DVBA growth and rupture, but the role of anti–tumor necrosis factor α therapy in DVBA has not been studied. Methods A retrospective, case–control study of DVBA at a single institution was performed. Two patients with DVBA were treated with infliximab (tumor necrosis factor α inhibitor) as part of routine therapy for rheumatoid arthritis. Three additional patients diagnosed with DVBA were studied as a control group. Routine brain magnetic resonance imaging/magnetic resonance angiography were measured by 2 blinded neuroradiologists to assess DVBA growth. Baseline comorbidities and clinical outcomes were assessed by chart review. Results The groups were similar with respect to baseline characteristics, and all patients were symptomatic at the time of DVBA diagnosis. One patient who started infliximab during the study period showed a reversal in DVBA growth rate trajectory, with a relative decrease in growth rate by 37% (0.49–0.18 mm2/day). Mean interval DVBA growth rates were lower during infliximab therapy than during noninfliximab observation intervals (0.13 versus 0.50 mm2/day; P = 0.09). Two patients in the control group died during the study period and 1 had a poor outcome (modified Rankin scale = 4). Both patients in the infliximab group had unchanged functional status (modified Rankin scale = 1) and no adverse events related to infliximab. Conclusion This study presents the first investigation of anti–tumor necrosis factor α therapy for DVBA. Infliximab was associated with low and decreasing DVBA growth trajectories with no treatment‐related adverse events. The effect of infliximab on clinical outcomes remains uncertain.https://www.ahajournals.org/doi/10.1161/SVIN.123.000890 |
| spellingShingle | Michael Travis Caton Kazim Narsinh Woody Han Ramani Chaganti Jonathan Graf Cathra Halabi Ethan Winkler Daniel L. Cooke A Preliminary Study of Anti‐TNFα Therapy for Symptomatic Dolichoectatic Vertebrobasilar Aneurysms Stroke: Vascular and Interventional Neurology |
| title | A Preliminary Study of Anti‐TNFα Therapy for Symptomatic Dolichoectatic Vertebrobasilar Aneurysms |
| title_full | A Preliminary Study of Anti‐TNFα Therapy for Symptomatic Dolichoectatic Vertebrobasilar Aneurysms |
| title_fullStr | A Preliminary Study of Anti‐TNFα Therapy for Symptomatic Dolichoectatic Vertebrobasilar Aneurysms |
| title_full_unstemmed | A Preliminary Study of Anti‐TNFα Therapy for Symptomatic Dolichoectatic Vertebrobasilar Aneurysms |
| title_short | A Preliminary Study of Anti‐TNFα Therapy for Symptomatic Dolichoectatic Vertebrobasilar Aneurysms |
| title_sort | preliminary study of anti tnfα therapy for symptomatic dolichoectatic vertebrobasilar aneurysms |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.123.000890 |
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