Effects of sildenafil citrate and etanercept treatment on TNF-α levels in peripheral blood of women with recurrent miscarriage

Objectives: The aim of the study was to determine serum concentrations of a proinflammatory cytokine, tumor necrosis factor-alpha (TNF-alpha), in patients with recurrent abortions undergoing treatment with sildenafil or etanercept. Material and methods: Serum TNF-alpha concentrations were determined for 24 patients with recurrent miscarriages (aged 32.7 +/- 4.64 years) deemed eligible for sildenafil therapy and 7 patients treated with etanercept (aged 37.65 +/- 5.45 years). Measurements were performed before and after therapy The control group included 10 healthy women (aged 33.3 +/- 5.49 years), who gave birth at least once without pregnancy-related complications. The levels of serum TNF-alpha were measured by Elisa. Results: Patients treated with etanercept had significantly elevated levels of TNF-alpha before therapy as compared to the control group (41.4 +/- 28.4 vs. 16.6 +/- 72 pg/ml). Moreover, we found a tendency for the concentration of TNF-alpha to increase in sera of patients treated with sildenafil after therapy completion (19 +/- 29 vs. 15.4 +/- 26.7 pg/ml). Treatment with etanercept resulted in a significant reduction of serum TNF-alpha levels (41.4 +/- 28.4 vs. 25.4 +/- 3.2 pg/ml). Conclusions: Therapy of recurrent abortions with anti-TNF-alpha drugs appears to be encouraging. Administration of blockers of phosphodiesterase type 5 or TNF-alpha blockers before conception seems to be a promising future therapy of immune-dependent recurrent miscarriages, limiting the teratogenic influence of the drugs on the fetus.