CANTOS: Canakinumab reduces total CV events in patients at high inflammatory risk
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Canakinumab reduced total CV events in patients with prior MI and residual inflammatory risk, according to new data from the CANTOS trial.
As Healio previously reported, in the main results of CANTOS, the anti-inflammatory drug canakinumab (Ilaris, Novartis) reduced risk for a first recurrent CV event — CV death, nonfatal stroke or nonfatal MI — at a median of 3.7 years, drawing attention to the inflammatory hypothesis of CAD.
For the present analysis, Brendan M. Everett, MD, MPH, FACC, associate professor of medicine at Brigham and Woman’s Hospital and Harvard Medical School, and colleagues analyzed whether canakinumab reduced total CV events in the CANTOS population during the study period.
Among the cohort of 10,061 patients (mean age, 61 years; 26% women; median C-reactive protein level, 4.2 mg/L; median LDL, 82.4 mg/dL), there were 3,417 serious CV events — MI, stroke, CV death or coronary revascularization — in 2,003 patients during the study period, Everett and colleagues wrote in the Journal of the American College of Cardiology.
The rates of total serious CV events were as follows:
- placebo group, 10.4 per 100 person-years;
- canakinumab 50 mg group, 8.4 per 100 person-years;
- canakinumab 150 mg group, 8.3 per 100 person-years; and
- canakinumab 300 mg group, 8.2 per 100 person-years.
Compared with the placebo group, all three canakinumab groups had lower rates of total serious CV events (rate ratio for 50 mg group = 0.8; 95% CI, 0.69-0.93; rate ratio for 150 mg group = 0.79; 95% CI, 0.68-0.92; rate ratio for 300 mg group = 0.78; 95% CI, 0.67-0.91), according to the researchers.
“These reductions indicate that inhibition of interleukin-1-beta in patients with established cardiovascular disease and subclinical vascular inflammation offers substantial benefits in reducing the burden of cardiovascular disease,” Everett and colleagues wrote.
In a related editorial, François Roubille, MD, PhD, from Université de Montpellier, France, and colleagues wrote, “The approach by the authors is appealing and should probably be considered as the preferred primary analysis in clinical research (and then included in the analysis plan from the start), although some limitations should not be discarded, especially the difficult clinical meaning.”
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