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Anti-inflammatory therapy in ischaemic heart disease: from canakinumab to colchicine

Felicita Andreotti1,2,3, Aldo Pietro Maggioni4,5, Alice Campeggi2

  • 1Direzione Scientifica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

European Heart Journal Supplements : Journal of the European Society of Cardiology
|October 15, 2021
PubMed

Insights

Anti-inflammatory drugs like canakinumab and colchicine show promise in preventing major cardiovascular events (MACE). Colchicine offers a favorable safety profile for secondary cardiovascular prevention in patients with ischemic heart disease.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Inflammation Research

Background:

  • Inflammation plays a crucial role in the pathophysiology of atherosclerotic cardiovascular disease.
  • Targeting inflammatory pathways is a potential strategy for secondary cardiovascular event prevention.
  • Recent trials have investigated various anti-inflammatory agents in high-risk patient populations.

Purpose of the Study:

  • To evaluate the efficacy and safety of different anti-inflammatory drugs in the secondary prevention of major cardiovascular events (MACE).
  • To compare the outcomes of canakinumab, colchicine, and methotrexate in patients with established or at-risk cardiovascular disease.

Main Methods:

  • Analysis of four large-scale randomized controlled trials (CANTOS, COLCOT, LoDoCo2, CIRT) involving over 25,000 patients.
  • Assessment of MACE, including myocardial infarction and stroke, as primary endpoints.
  • Evaluation of drug safety profiles, including infection rates, pneumonia, and secondary malignancies.

Main Results:

  • Canakinumab (anti-IL-1β) reduced MACE but increased fatal infections.
  • Colchicine (NLRP3 inflammasome inhibitor) demonstrated MACE prevention with a slight increase in pneumonia risk in one trial.
  • Methotrexate showed no significant reduction in MACE and was associated with increased skin cancer risk.

Conclusions:

  • Canakinumab and colchicine have demonstrated efficacy in preventing MACE in patients with ischemic heart disease.
  • Colchicine exhibits a more favorable safety and cost profile for secondary cardiovascular prevention compared to canakinumab.
  • Further research is ongoing, with expected results for anti-IL-6 therapies like ziltivekimab.

Keywords:
AtherothrombosisCanakinumabColchicineInflammationIschaemic heart disease

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