Anti-Inflammatory Therapy With Canakinumab for the Prevention and Management of Diabetes |
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Authors: | Brendan M. Everett Marc Y. Donath Aruna D. Pradhan Tom Thuren Prem Pais Jose C. Nicolau Robert J. Glynn Peter Libby Paul M Ridker |
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Affiliation: | 1. Center for Cardiovascular Disease Prevention, Harvard Medical School, Boston, Massachusetts;2. Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;3. Endocrinology, Diabetes & Metabolism, University Hospital Basel, Basel, Switzerland;4. Division of Cardiovascular Medicine, Department of Medicine, VA Boston Medical Center, West Roxbury, Massachusetts;5. Novartis Pharmaceutical Corporation, East Hanover, New Jersey, and Basel, Switzerland;6. St. John’s Research Institute, Bangalore, India;7. Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil |
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Abstract: | BackgroundSubclinical inflammation mediated in part by interleukin (IL)-1β participates in peripheral insulin resistance and impaired pancreatic insulin secretion.ObjectivesThe authors tested the hypothesis that the IL-1β inhibitor canakinumab reduces incident diabetes.MethodsThe authors randomized 10,061 patients with prior myocardial infarction and high-sensitivity C-reactive protein (hsCRP) ≥2 mg/l to placebo or canakinumab at doses of 50 mg, 150 mg, or 300 mg subcutaneously once every 3 months. The authors tested the effects of canakinumab on major cardiovascular events in patients with and without diabetes at baseline, and evaluated as a pre-specified analysis whether canakinumab would reduce the risk of adjudicated cases of new-onset type 2 diabetes among those with protocol-defined pre-diabetes at trial entry. The authors also evaluated the effect of canakinumab on fasting plasma glucose and glycosylated hemoglobin (HbA1c) in patients with and without established diabetes.ResultsOf the participants, 4,057 (40.3%) had baseline diabetes, 4,960 (49.3%) had pre-diabetes, and 1,044 (10.4%) had normal glucose levels. Among those without diabetes, increasing tertiles of hsCRP at baseline associated with an increased risk of developing diabetes during the median follow-up period of 3.7 years (incidence rates 3.2, 4.1, and 4.4 per 100 person-years; p = 0.003). Canakinumab 150 mg as compared with placebo had similar magnitude effects on major cardiovascular event rates among those with diabetes (hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.70 to 1.03), pre-diabetes (HR: 0.86; 95% CI: 0.70 to 1.06), and normoglycemia (HR: 0.81; 95% CI: 0.49 to 1.35). Despite large reductions in hsCRP and IL-6, canakinumab did not reduce the incidence of new-onset diabetes, with rates per 100 person-years in the placebo, 50 mg, 150 mg, and 300 mg canakinumab groups of 4.2, 4.2, 4.4, and 4.1, respectively (log-rank p = 0.84). The HR comparing all canakinumab doses to placebo was 1.02 (95% CI: 0.87 to 1.19; p = 0.82). Canakinumab reduced HbA1c during the first 6 to 9 months of treatment, but no consistent long-term benefits on HbA1c or fasting plasma glucose were observed.ConclusionsAlthough IL-1β inhibition with canakinumab had similar effects on major cardiovascular events among those with and without diabetes, treatment over a median period of 3.7 years did not reduce incident diabetes. (Canakinumab Anti-inflammatory Thrombosis Outcomes Study [CANTOS]; NCT01327846) |
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Keywords: | cardiovascular disease diabetes inflammation randomized trial CI confidence interval glycosylated hemoglobin HR hazard ratio hsCRP high-sensitivity C-reactive protein IL interleukin IQR interquartile range NF-κB nuclear factor kappa-B NLRP3 NOD-like receptor pyrin-3 |
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