title: Effects of interleukin-1β inhibition with canakinumab on hemoglobin A1c, lipids, C-reactive protein, interleukin-6, and fibrinogen: a phase IIb randomized, placebo-controlled trial.
abstract: BACKGROUND
  To test formally the inflammatory hypothesis of atherothrombosis, an agent is needed that reduces inflammatory biomarkers such as C-reactive protein, interleukin-6, and fibrinogen but that does not have major effects on lipid pathways associated with disease progression.
  
  
  RESULTS
  We conducted a double-blind, multinational phase IIb trial of 556 men and women with well-controlled diabetes mellitus and high cardiovascular risk who were randomly allocated to subcutaneous placebo or to subcutaneous canakinumab at doses of 5, 15, 50, or 150 mg monthly and followed over 4 months. Compared with placebo, canakinumab had modest but nonsignificant effects on the change in hemoglobin A1c, glucose, and insulin levels. No effects were seen for low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or non-high-density lipoprotein cholesterol, although triglyceride levels increased ≈10% in the 50-mg (P=0.02) and 150-mg (P=0.03) groups. By contrast, the median reductions in C-reactive protein at 4 months were 36.4%, 53.0%, 64.6%, and 58.7% for the 5-, 15-, 50-, and 150-mg canakinumab doses, respectively, compared with 4.7% for placebo (all P values ≤0.02). Similarly, the median reductions in interleukin-6 at 4 months across the canakinumab dose range tested were 23.9%, 32.5%, 47.9%, and 44.5%, respectively, compared with 2.9% for placebo (all P≤0.008), and the median reductions in fibrinogen at 4 months were 4.9%, 11.7%, 18.5%, and 14.8%, respectively, compared with 0.4% for placebo (all P values ≤0.0001). Effects were observed in women and men. Clinical adverse events were similar in the canakinumab and placebo groups.
  
  
  CONCLUSIONS
  Canakinumab, a human monoclonal antibody that neutralizes interleukin-1β, significantly reduces inflammation without major effect on low-density lipoprotein cholesterol or high-density lipoprotein cholesterol. These phase II trial data support the use of canakinumab as a potential therapeutic method to test directly the inflammatory hypothesis of atherosclerosis.
authors.affiliation: MPH, Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, 900 Commonwealth Ave East, Boston, MA 02215-1204, USA. pridker@partners.org
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ridker
authors.forename: Campbell P
authors.initials: CP
authors.lastname: Howard
authors.forename: Verena
authors.initials: V
authors.lastname: Walter
authors.forename: Brendan
authors.initials: B
authors.lastname: Everett
authors.forename: Peter
authors.initials: P
authors.lastname: Libby
authors.forename: Johannes
authors.initials: J
authors.lastname: Hensen
authors.forename: Tom
authors.initials: T
authors.lastname: Thuren
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000037:antagonists & inhibitors* / Q000378:metabolism; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D004311:Double-Blind Method; D005260:Female; D005340:Fibrinogen / Q000037:antagonists & inhibitors / Q000378:metabolism*; D006442:Glycated Hemoglobin / Q000037:antagonists & inhibitors* / Q000378:metabolism; D006801:Humans; D018836:Inflammation Mediators / Q000627:therapeutic use*; D053583:Interleukin-1beta / Q000037:antagonists & inhibitors* / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D050356:Lipid Metabolism / Q000187:drug effects / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult; D000093242:Interleukin-6 Inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D015415:Biomarkers; D002097:C-Reactive Protein; D005340:Fibrinogen; D006442:Glycated Hemoglobin; D018836:Inflammation Mediators; D053583:Interleukin-1beta; D015850:Interleukin-6; D000093242:Interleukin-6 Inhibitors; C508600:IL6 protein, human; C517652:hemoglobin A1c protein, human; C541220:canakinumab