The CANTOS Trial is a landmark study because it tested for the first time the hypothesis that blocking an important component of the inflammatory cascade involved in atherosclerotic heart disease will be translated into an improved outcome.
The positive results of the study certainly open new doors to the prevention and treatment of cardiovascular disease.
The data suggesting that canakinumab may reduce incident lung cancer and lung cancer mortality are of great interest but need to be confirmed by further studies.
However, the modest absolute clinical benefit and the high price of canakinumab can hardly justify its routine use in patients with coronary artery disease. Furthermore, more data is needed to understand the safety trade-offs involved in the long-term use of the drug.
Interestingly, the CANTOS trial has defined a high-risk subgroup of patients with coronary artery disease and metabolic abnormalities characterized by visceral obesity, insulin resistance, inflammation and adipocyte dysfunction.
The results of the study inevitably raise the question whether reducing inflammation by improving diet and lifestyle will provide similar results as treatment with an expensive drug with potential side effects.
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