The safety of an adenosine A1-receptor antagonist, rolofylline, in patients with acute heart failure and renal impairment: Findings from PROTECT

John R. Teerlink, Vicente J. Iragui, Jay P. Mohr, Peter E. Carson, Paul J. Hauptman, David H. Lovett, Alan B. Miller, Ileana L. Piña, Scott Thomson, Paul D. Varosy, Michael R. Zile, John G.F. Cleland, Michael M. Givertz, Marco Metra, Piotr Ponikowski, Adriaan A. Voors, Beth A. Davison, Gad Cotter, Denise Wolko, Paul DeLuccaChristina M. Salerno, George A. Mansoor, Howard Dittrich, Christopher M. O'Connor, Barry M. Massie

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Background: Adenosine exerts actions in multiple organ systems, and adenosine receptors are a therapeutic target in many development programmes. Objective: The aim of this analysis was to evaluate the safety of rolofylline, an adenosine A1-receptor antagonist, in patients with acute heart failure. Methods: The effect of rolofylline was investigated in patients hospitalized for acute heart failure with impaired renal function. Intravenous rolofylline 30mg or placebo was infused over 4 hours daily for up to 3 days. Adverse events (AEs) and serious AEs (SAEs) were recorded from baseline through 7 and 14 days, respectively, and clinical events were adjudicated through 60 days. Results: Of 2033 patients enrolled, 2002 received study drug randomized 2 : 1 to rolofylline or placebo. Rolofylline and placebo were associated with a similar risk of pre-specified groups of AEs or SAEs, other than selected neurological events. Investigator-reported seizures occurred in 11 (0.8%) rolofylline-treated patients and zero patients receiving placebo (p = 0.02). Stroke occurred in 21 (1.6%) patients assigned to rolofylline compared with 3 (0.5%) placebo-treated patients through 60 days with a greater risk for stroke in the rolofylline group (hazard ratio 3.49; 95%CI 1.04, 11.71; p = 0.043). There was no temporal relation to rolofylline administration and no specific stroke subtype or clinical characteristics that predicted stroke in the rolofylline group. Conclusions: Rolofylline treatment was associated with an increased seizure rate, an anticipated complication of A1-receptor antagonists. An unanticipated, disproportionate increase in strokes in the rolofylline-treated patients emerged, although no clear temporal relation, aetiology, stroke subtype or interacting factor suggestive of a causal mechanism was identified. Further research into stroke as a potential complication of adenosine-modulating therapies is required. Additionally, this study underscores the value of longer follow-up durations for AEs, even for agents with short treatment periods, such as in acute heart failure. Trial Registration: identifiers NCT00328692 and NCT00354458.

Original languageEnglish (US)
Pages (from-to)233-244
Number of pages12
JournalDrug Safety
Issue number3
StatePublished - 2012
Externally publishedYes


  • Acute-heart-failure
  • Adenosine-A1-receptor-antagonists
  • Myocardial- infarction
  • Myocardial-ischaemia
  • Renal-impairment
  • Rolofylline

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Pharmacology (medical)


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