Canakinumab therapy targeting the IL-1β pathway reduced cardiovascular and all-cause mortality by 31% among patients who achieved the largest reductions in hsCRP.
Does anti-inflammatory therapy targeting the IL-1 pathway reduce atherothrombotic risk in patients with residual inflammatory risk?
Patients with residual inflammatory risk (elevated hsCRP) despite control of conventional risk factors and lipid lowering
Anti-inflammatory therapy targeting the interleukin (IL)-1-to-IL-6-to-CRP signaling pathway (e.g., canakinumab)
Standard of care / lipid lowering alone
Vascular events and atherothrombotic riskhard clinical
Targeting the IL-1β inflammatory pathway provides atheroprotection and reduces cardiovascular mortality in patients with residual inflammatory risk, independent of lipid lowering.
Life-threatening cardiovascular events occur despite control of conventional risk factors. Inflammation, as measured by high-sensitivity C-reactive protein (hsCRP) concentration, is associated with future vascular events in both primary and secondary prevention, independent of usual risk markers. Statins are powerful lipid-lowering agents with clinically relevant anti-inflammatory effects. Recent data support targeting the interleukin (IL)-1-to-IL-6-to-CRP signaling pathway as an adjunctive method for atheroprotection. The CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) trial showed that reducing inflammation through IL-1β inhibition significantly reduced vascular risk, beyond that achievable with lipid lowering. CANTOS further demonstrated a 31% reduction in cardiovascular mortality and all-cause mortality among patients treated with canakinumab who achieved the largest reductions in hsCRP, as well as efficacy in high-risk patients with chronic kidney disease and diabetes. This review outlines the clinical implications of CANTOS for patients with "residual inflammatory risk," the potential benefits and risks associated with anti-inflammatory therapy, and the importance of CANTOS for future drug development.
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Paul M. Ridker
Journal of the American College of Cardiology
Brigham and Women's Hospital
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Paul M. Ridker (Thu,) conducted a review in Atherothrombotic risk. Canakinumab (IL-1β inhibition) was evaluated. Canakinumab therapy targeting the IL-1β pathway reduced cardiovascular and all-cause mortality by 31% among patients who achieved the largest reductions in hsCRP.
www.synapsesocial.com/papers/69ecdb66eb2c6328dba62cdc — DOI: https://doi.org/10.1016/j.jacc.2018.06.082