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Q J Med 2000; 93: 305-311
© 2000 Association of Physicians

Commentary

New therapies for heart failure: is thalidomide the answer?

P.P. Davey and H. Ashrafian

From the Nuffield Department of Medicine, Oxford University, John Radcliffe Hospital, Oxford, UK

The syndrome of advanced heart failure is associated with considerable morbidity and mortality. Ideas about the reasons for the progressive nature of the heart failure syndrome have changed over the years, with the initial view that progression was principally due to pump failure (the ‘haemodynamic’ hypothesis), giving way to more modern views, which implicate neuro-endocrine activation (including catecholamine excess, renin-angiotensin system activation, etc.). More recently, an excess of inflammatory cytokines has been found in advanced heart failure and implicated in the progression of the disease. Amongst the cytokines found, TNF-{alpha} seems to be particularly important. The principle therapeutic action of thalidomide appears to be reduction of TNF-{alpha} levels. We therefore suggest that there may be a role for thalidomide, or its derivatives, in the management of advanced heart failure.

Address correspondence to Dr P.P. Davey, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford OX3 9DY. e-mail: patrick.davey{at}ndm.ox.ac.uk


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