In patients with a prior myocardial infarction (MI), the magnitude of reduction in high-sensitivity C-reactive protein (hsCRP), in the absence of any change in LDL cholesterol, was "strongly related to cardiovascular event reduction and all-cause mortality reduction following canakinumab therapy," according to results of the CANTOS trial presented Nov. 13 at AHA 2017 in Anaheim, CA, and simultaneously published in The Lancet.

Paul M. Ridker, MD, MPH, FACC, et al., looked at 10,061 men and women post-MI with established atherosclerosis and hsCRP ≥ 2 mg/L in 39 countries. Patients randomly received placebo or either 50 mg, 150 mg or 300 mg of canakinumab – a monoclonal antibody targeting interleukin-1β – given subcutaneously every three months. The median follow-up time was three and four years.

Results showed that patients in the canakinumab group who achieved hsCRP concentrations less than 2 mg/L had a 25 percent reduction in major adverse cardiac events, whereas no significant benefit was observed among those with on-treatment hsCRP concentrations of 2 mg/L or above.

In addition, for those treated with canakinumab who achieved on-treatment hsCRP concentrations less than 2 mg/L, cardiovascular mortality and all-cause mortality were both reduced by 31 percent, whereas no significant reduction in the endpoints was observed among those treated with canakinumab who achieved hsCRP concentrations of 2 mg/L or above.

The authors conclude that "the magnitude of hsCRP reduction following a single dose of canakinumab might provide a simple clinical method to identify individuals most likely to accrue the largest benefit from continued treatment."

Keywords: AHA17, AHA Annual Scientific Sessions, Cholesterol, Risk

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