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CANTOS Trial Marks a New Direction in Atherosclerosis Treatment
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CANTOS Trial Marks a New Direction in Atherosclerosis Treatment
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Upload Date:
2024-04-09T00:00:00.0000000
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Language: EN.
Segment:0 .
>> Practice Impact Extra podcasts are derived from Hurst's, The Heart Board Review, and other online resources available only through accesscardiology.com. >> European Society of Cardiology meetings are very important meetings. They're important because they give a flavor to what is going on in populations that aren't necessarily in America, but sometimes trials and studies that do involve the American population. [ Music ] Hi, Dr. Bernie here, and welcome to Practice Impact Extra.
Today, we would like to kind of discuss some of the important and provocative studies that were presented at the European Society of Cardiology meetings in August this year, 2017 and particularly speak about the CANTOS trial, the COMPASS trial, the PURE study, and revisit the CLARIFY trial, all I think very important practice-impacting presentations a month ago. They're very good studies most of the time and some very good researches, and good researchers do usually good studies.
And so, I think the information that one can glean from those meetings is very important, but there's so many things that are presented. This particular meeting, I thought was exceptional for a lot of very interesting topic presentations. And so, when you start to choose which ones you want to present, well, probably all of them. They are probably 10 or 12 that would be worth discussing. Having said that, the focus of our podcast is Practice Impact Extra, so we're looking for those programs and those -- excuse me -- those studies and trials that will have some impact or get you to think about what is now, what you should know right now that may or may not impact, you know, far down the road, but probably soon down the road.
So, selecting things that I think are probably of value is why I chose these four -- these four studies. And plus, these are four studies, at least three of them, that have a lot of buzz. I think it's because of controversy and because of whether or not you can accept them at face value or whether or not more research is necessary. So, I thought this would be some studies that I thought I would want to share with you because I think they caught my attention and the attention many others and hopefully, they'll be important for your attention.
So, let's begin, and certainly, if I really wanted to summarize the European Society of Cardiology meetings, I think they are -- and they ended in the end of August in 2017, just a month ago. There are two words I think best highlight and describe the meeting, and one word is exciting, and the other one is fascinating. I think those are pretty good terms. And there were a lot of, as I mentioned, informative presentations, and I've kind of taken four that I think are provocative and are practice impacting.
Let's begin with the CANTOS trial. The CANTOS trial literally had everyone talking, and the reason for this, it's a historic landmark study. It validates the inflammatory concept of atherosclerosis. So, what did the results reveal? Well, the study was for a treatment of a specific anti-inflammatory drug, and this anti-inflammatory drug is called canakinumab, and that's a monoclonal antibody that blocks the inflammatory pathways, particularly the interleukin-1 beta inflammatory pathway.
What this study did -- excuse me -- this trial did show that this agent was able to reduce cardiovascular events. So, the trial had 10,000 patients recruited with a history of myocardial infarction. So, they have established myocardial disease and infarction, they all had elevated C-reactive proteins, so there was an elevated inflammatory state, and they were already all on high-dose statin. I think that's pretty important.
And so, the patients received canakinumab at three different doses just once every 3 months compared to placebo. And the study was followed for about 3.7 years. And so, what did we see for results? Okay, the first thing, cholesterol levels, they were not changed significantly in the canakinumab study group. So, this drug, this anti-inflammatory drug, did not impact on cholesterol levels. However, the C-reactive protein, the inflammatory marker, was reduced significantly by 37% at the 150 milligram dose and 41% on the 300 milligram dose.
And when we looked at the reduction in coronary artery events, there was a 27% relative reduction in cardiovascular events. There, however, was no difference in all-cause mortality. So, we did have events that went down, but no difference in all-cause mortality. I thought there was something very, very important in this study, and there was an exploratory analysis. There was, at the beginning of this trial, a pre-specified cancer event look.
So, it's been kind of known that these anti-inflammatory agents can and may impact on cancer. So, this trial had a second analysis looking at that, and this was pre-specified. And what did they find? There was a 51% reduction in cancer mortality. There was a 67% reduction in the incidence of lung cancer. There was a 77% reduction in lung cancer mortality.
So, a significant pre-specified cancer reduction, particularly noted in the lung cancer patients and those who could potentially develop it. And there was a moderate amount of smokers in this group. I don't think what we got out of the study, however, is what the mechanism is, and I think the mechanism for why it had such an impact in lung cancer remains a mystery. And, obviously, this is going to continue to be investigated. So, that sounds like a lot of interesting and good news, but always there's the other side of the coin, and that is what are the issues that also surround the study and the drug?
And there's two, safety and cost. When we look at safety, if you took a look at the diabetic group that was in part of that 10,000 recruited patients, there was a particularly high instance of fatal -- fatal infection in that diabetic group. A little alarming. And the yearly cost as an orphan drug was about $200,000. So, a couple of important issues regarding the study and the use of the drug.
And so, what's my take from this study? Well, for sure one thing, CANTOS provided a new scientific direction in atherosclerosis. Beyond the lower-is-better cholesterol hypothesis, I think that this study validates the inflammatory concept. I think that's very, very important. This is the first time I think we've had some validation of this. But as I mentioned, with some of the issues at the end, we certainly need more efficacy and safety trials to give more information regarding which patients will benefit from this anti-inflammatory treatment or the future of other anti-inflammatory drug treatments in the treatment of atherosclerosis.
Thanks so much for joining me on Practice Impact Extra, and I hope that you'll join me next time. Thank you. >> We hope you enjoyed this podcast from McGraw-Hill. Subscribers to AccessCardiology have instant access to over 25,000 pages of rich medical content, receive medical updates from trusted experts, and have access to other special features. To subscribe or learn more, please visit accesscardiology.com.
