Lung cancer and myocardial infarctions (MI) are relatively common conditions in clinical practice. Both conditions are engendered by lifestyle factors such as an imbalanced diet, smoking, high blood pressure and environmental pollution, to name a few.

The discovery of the drug, Canakinumab, which not only reduces risk of heart attacks – but, also cuts down the risk of lung cancer – is indeed groundbreaking.

How the drug works

For many years, the primary focus of preventing heart attacks has been about diminishing cholesterol levels. This new drug adopts a novel approach by preventing inflammatory changes. Inflammation is a critical step in the development of atheromatous plaque, and subsequently myocardial infarctions.

The drug works by inhibiting the action of an important inflammatory mediator, interleukin-1, which triggers harmful remodeling of vascular endothelial cells – further stimulating other inflammatory reagents. Canakinumab also lowers C-reactive protein (CRP), which is a potent indicator of inflammation.

Inflammation is also an important target because individuals who have a myocardial infarction once are predisposed to another heart attack. Inflammation within the arteries appears to be the cause, in 50% of these recurrent cases.

Protection against heart attacks, lung cancer, arthritis and gout

The study was funded by Novartis and was published in both the New England Journal of Medicine and The Lancet. The four-year project included 10,000 trial patients who had suffered heart attacks.

The novelty of the drug lies in the fact that it has a protective effect against several important medical conditions including arthritis. As arthritis involves chronic inflammation localised to joints, this drug is able to reverse critical inflammatory changes that lead to joint degeneration.

For cancer, this drug has been shown to approximately halve the risk. Nonetheless, further research is mandatory to determine whether reduced risk of these conditions is simply a side effect of the drug, or there is a causal pathway through which this drug acts.

Dr Paul Ridker, chief investigator from the Brigham and Women’s Hospital, has demonstrated that this drug can reduce the risk of cardiovascular events by approximately 15%. The lowest dose of the drug administered to the trial patients lowered rates of lung cancer “by 26%”. The highest dose was associated with a staggering drop of 67% in rates of lung cancer.

This drug is administered via injections approximately four times each year, which is quite reasonable for a drug that is so clinically efficacious. Dr Ridker comments on how targeting inflammation is more beneficial as hypercholesterolaemia is not present in approximately 50% of heart attack patients: “For the first time, we’ve been able to definitively show that lowering inflammation independent of cholesterol reduces cardiovascular risk,” he elaborates.

The shortcomings of this anti-inflammatory superdrug

However, Canakinumab is shown to elevate the risk of life-threatening infections in patients, with a ratio of about 1 patient in every 1,000 patients treated. Diabetic and geriatric patients are most likely to be affected by this. There are also notable side-effects of this drug and these may be particularly pronounced when taken at higher doses to prevent progression of existing tumours.

A significant drawback of this drug appears to be the fact that it costs approximately GBP40,000 per year to treat a patient. This is in stark contrast to the cost of statins, which is a mere GBP20; and has been used historically as a proven preventative medication. Whether the costs will outweigh the benefits or vice versa, only further research on the mechanisms of this drug will be able to tell. MIMS

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