Canakinumab Does Not Appear to Prevent Diabetes Onset

The CANTOS trial enrolled more than 10,000 patients
The CANTOS trial enrolled more than 10,000 patients

Canakinumab (Ilaris; Novartis), an interleukin-1β blocker, did not reduce the risk of newly diagnosed diabetes in patients with prediabetes, according to new data from the CANTOS study presented at ACC.18 Scientific Sessions & Expo.

Study results reported last year from CANTOS showed that treatment with canakinumab significantly reduced major adverse cardiovascular events (MACE) in patients with a history of heart attack and elevations in high-sensitivity C-reactive protein (hsCRP) (primary endpoint). A key secondary endpoint of CANTOS was to evaluate whether canakinumab would lower the risk of new onset type 2 diabetes in patients with prediabetes. 

In the CANTOS study, patients were randomized to subcutaneous canakinumab 50mg, 100mg, or 300mg once every 3 months or placebo for a median of 3.7 years. After study completion, researchers followed up with those who had baseline prediabetes. 

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Initially, patients with prediabetes (N=4,960) had a reduction in median HbA1c after 6 months of receiving canakinumab from 5.8% to 5.6%. But after 9 months, this reduction was no longer sustained and patients progressed to diabetes at a rate similar to those in the placebo arm; reductions in hsCRP and interleukin-6, however, were still seen. 

Lead author, Brendan Everett, MD, from Brigham and Women's Hospital, said, "It suggests that alternative inflammatory pathways may be more critical to the development of diabetes than inhibition of interleukin-1 beta, which was the specific mechanism we tested in this study." 

In a secondary analysis, researchers looked at the effect of canakinumab on blood glucose among patients with diabetes at baseline. Treatment with canakinumab resulted in similar changes in glucose levels as seen in patients with prediabetes, however patients in both the canakinumab and placebo arms still needed a similar number of antidiabetes treatments.

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Everett B, Glynn R, Thuren T, et al. Anti-Inflammatory Therapy with Canakinumab and Incident Type 2 Diabetes: A Pre-Specified Key Secondary Endpoint of the CANTOS Trial. Presented at: ACC.18 Scientific Sessions & Expo. March 10–12, 2018; Orlando, FL. Abstract #408-10.