At last, some heartening news
A ray of sunshine has shone through the cloud of gloom that envelopes British medicine. Canakinumab – an anti-inflammatory drug – has been investigated by Novartis, a pharmaceutical company, for treatment of rheumatoid arthritis for years. It has now shown signs that it might possibly be helpful for such problems as gout, obstructive lung disease and, statistically most importantly, coronary arterial disease.
Currently, the injections are discouragingly expensive but, once a drug becomes generally used, its cost tumbles. If it proved to be helpful, there would be savings from a reduction in the number of patients needing hospital admission for such treatments as bypass surgery and stent-fitting.
The recent research on Canakinumab has been with patients who were also usually taking statins. Even if it proves to be a revolutionary drug, statins will still be essential.
Despite all the statistics – that demonstrate the advantages of taking statins and their potential for reducing the death rate from coronary arterial disease and, to a lesser extent, strokes – many patients and some doctors still refuse to accept its widespread use.
Nobody denies that, if taken late in the day, statins will in some cases worsen insomnia. In some other people, they may cause relatively mild aches and pains. The most determined of the anti-statin brigade emphasise the very occasional case in which statins can induce widespread muscle damage and consequent kidney failure. A simple blood test will rapidly differentiate the difference between the common problem of mild aches and pains, from the tiny percentage of people who develop serious muscular problems, and renal failure.
It is generally believed that the success of statin treatment is entirely related to its ability to reduce cholesterol levels. The cardiologist who introduced me, and my former patients, to statins was careful to show me the statistics. They demonstrated that, although there was massive evidence that statins reduced cholesterol, the effect on the heart attack incidence was greater than could be solely accounted for by its cholesterollowering power. He suggested that there must be other factors at play. It was his bet that statins must have some antiinflammatory action as well.
Twenty-three years after my lunch with the cardiologist who persuaded me of the advantages of statins, his hunch – that an anti-inflammatory factor would also be likely to be significant – has been strengthened. The cardiologist’s belief in the anti-inflammatory action, as well as the cholesterol-lowering effect, have been supported by evidence given at the recent meeting of the European Society of Cardiology.
Research workers, led by those from Brigham and Women’s Hospital in Boston, in the US, have investigated more than 10,000 patients with proven coronary arterial disease. Their work demonstrates that inflammatory problems, including arterial disease, might benefit from treatment with Canakinumab injections.
Canakinumab is an anti-inflammatory agent. The trial showed that those patients – forty per cent of whom were also diabetic – given Canakinumab were fourteen per cent less likely to have repeat cardio-vascular incidents.
An unexpected finding was that the treated patients, as opposed to those having a placebo, also had a greater chance of surviving cancer for a longer time. Overall cancer death rates during the relatively short period of the trial were reduced by fifty per cent in those treated with Canakinumab.
The proof that inflammation is, as expected, an important factor in the treatment of coronary arterial disease and the common cause of strokes is an important milestone in medicine.
It is currently unlikely that Canakinumab will be of such general use as statins for various reasons. At the moment, it is monstrously expensive; and, like many other antiinflammatory agents, it can make some patients more liable to become seriously ill from any infection.