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Guardian online - anti-inflammatories may lower heart attack risk

Teaser in case anyone isn't sure about clicking through.
Anti-inflammatory injections could lower the risk of heart attacks and may slow the progression of cancer, a study has found, in what researchers say is the biggest breakthrough since the discovery of statins.

Heart attack survivors given injections of a targeted anti-inflammatory drug called canakinumab had fewer attacks in the future, scientists found. Cancer deaths were also halved in those treated with the drug, which is normally used only for rare inflammatory conditions.

Statins are the mainstay drugs for heart attack prevention and work primarily by lowering cholesterol levels. But a quarter of people who have one heart attack will suffer another within five years despite taking statins regularly. It is believed this is because of unchecked inflammation within the heart’s arteries.

The research team, led from Brigham and Women’s hospital in Boston, tested whether targeting the inflammation with a potent anti-inflammatory agent would provide an extra benefit over statin treatment.

ETA: From Wikipedia
Canakinumab (INN, trade name Ilaris, previously ACZ885)[2] is a human monoclonal antibody targeted at interleukin-1 beta. It has no cross-reactivity with other members of the interleukin-1 family, including interleukin-1 alpha.[3]

Canakinumab was approved for the treatment of cryopyrin-associated periodic syndromes (CAPS) by the U.S. Food and Drug Administration (FDA) in June 2009[4] and by the European Medicines Agency in October 2009.[5] CAPS is a spectrum of autoinflammatory syndromes including familial cold autoinflammatory syndrome, Muckle–Wells syndrome, and neonatal-onset multisystem inflammatory disease. In September 2016, FDA approved the use of canakinumab on 3 additional rare and serious auto-inflammatory diseases:[6] Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPS), Hyperimmunoglobulin D Syndrome (HIDS)/Mevalonate Kinase Deficiency (MKD) and Familial Mediterranean Fever (FMF).
https://en.wikipedia.org/wiki/Canakinumab
 

RogerBlack

Senior Member
Messages
902

No, it's not - quite - as simple as this. But there is a major element of truth.
The cost of one dose is ~$10000

https://www.nice.org.uk/advice/esnm23/chapter/Key-points-from-the-evidence

The cost of even quite intensive other interventions (lifestyle to reduce reccurance risk) may be lots lower than this. Never mind aspirin.


Paper at:
http://www.nejm.org/doi/full/10.1056/NEJMoa1707914#t=article

nejmoa1707914_f2.jpeg


Seems to be the money shot.
The hazard ratio climbing back towards 1 for the 300mg dose leaves me wondering if there could be major statistical artifacts. I'd need to dig deeper into it.

The best case reduction of ~15% seems also questionable - $10K or so is a lot of money you can plow into nonpharmaceutical risk reduction.
 
Last edited:

anni66

mum to ME daughter
Messages
563
Location
scotland
Choleresterol is the elephant in the room. They desparately need to find other uses for statins.
Insulin resistance is one of the largest drivers of inflammation.
 

RogerBlack

Senior Member
Messages
902
That's in the US, right? What would be the cost of this drug in the UK? I'm not sure of the magnitude of the US markup on drugs. I seem to recall its pretty huge (especially for drugs whose cost may include special medical services like infusions).

The NICE page gave the UK cost, which was about the same as a quick googling of the price in the US.
 
Messages
3,263
@RogerBlack, I just read this interesting article:

http://www.theaustralian.com.au/bus...g/news-story/3a01f2552e0fe4fdd79b3059a03bfef3

Its suggests that the currently high price of this drug is driven largely by the rarity of the conditions it treats (so few opportunities to recoup profits), and that that would change if it became a more widely used drug:
article said:
Novartis recently discovered that a drug it sells for a group of very rare diseases could be used to treat a much more common ailment. There is just one problem: its $US16,000-per-dose ($A21,000) price tag.

The drug, called ACZ885, is already sold under the brand name Ilaris for certain rare inflammatory disorders affecting a very small number of people. But a recent clinical trial suggests it could also reduce the risk of serious complications like strokes in people who have suffered a heart attack.

If the drug does pan out with regulators, Novartis would have to drastically cut its price to make it competitive with other cardiovascular drugs. That would mean jettisoning a small, but reliable, revenue stream on an uncertain bet that the drug could become a top seller as a cardiovascular medicine.
Interestingly, this would also lower the price for those with rare diseases too.

(This could be important us - this drug might turn out to be useful for a subset of us).
 

Gingergrrl

Senior Member
Messages
16,171
But a quarter of people who have one heart attack will suffer another within five years despite taking statins regularly.

Does anyone know if this statistic is accurate? I'm curious in regard to a family member who had a heart attack a few months ago (not myself) and although was put on a statin, a beta blocker, and a blood thinner b/c had balloon angioplasty and stent put in during an emergency surgery post heart attack, given this person's history, I am doubtful he will continue with the meds long-term (or even short-term).

Canakinumab (INN, trade name Ilaris, previously ACZ885)[2] is a human monoclonal antibody targeted at interleukin-1 beta. It has no cross-reactivity with other members of the interleukin-1 family, including interleukin-1 alpha.[3]

I'm confused how this would help to prevent a second heart attack? It is a MAB drug (monoclonal antibody) so I assume in the same class as Rituximab but it is to prevent heart attacks? Is it given via IV or injection? Sorry for my confusion!

That's in the US, right? What would be the cost of this drug in the UK? I'm not sure of the magnitude of the US markup on drugs. I seem to recall its pretty huge (especially for drugs whose cost may include special medical services like infusions).

Yes, all drug prices are jacked up in the US and no price caps are placed on Pharma which is the most powerful lobby in the country (except maybe the NRA)?