Anti-inflammatory therapy for atherosclerosis. Results of the CANTOS trial

Several hypotheses have been postulated on the development of atherosclerosis. The most elaborate of them is the lipidtheory the validity of which has been supported by the results of many clinical trials of hypolipidemic drugs. There is nodoubt that vessel wall inflammation plays an important role in the development of atherosclerosis, but so far no directevidence has existed for the validity of the inflammatory hypothesis. In the CANTOS clinical trial, three doses of the humanmonoclonal anti-interleukin-1β antibody canakinumab were tested versus placebo in a randomized fashion in postmyocardialinfarction patients who simultaneously had increased plasma levels of hs-CRP ≥ 2 mg/L. Canakinumab significantlydecreased hs-CRP levels without influencing the lipidogram findings in any way. The doses of 150 and 300 mg of canakinumabadministered s.c. once every 3 months in comparison with placebo have significantly decreased the cumulative incidenceof cardiovascular events by 15 %. The results of the CANTOS trial are thus the first direct confirmation of the inflammatoryhypothesis of atherosclerosis. An unexpected non-cardiovascular result was the reduction in cancer mortality, especiallythat in bronchopulmonary cancer.

Keywords: canakinumab, inflammatory theory of atherosclerosis, CANTOS trial