At last, some heart­en­ing news

The Oldie - - TOM STUTTAFORD: THE DOCTOR’S SURGERY -

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.

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