Intervention
Canakinumab
Last updated Sat May 30 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
RCT evidence— CANTOS proof of inflammation hypothesis
What it is
A fully human IgG1κ monoclonal antibody against IL-1β, the mature cytokine produced by NLRP3-inflammasome activation. Half-life ~26 days allows quarterly dosing.
CANTOS — the landmark trial
- 10,061 post-MI patients with hsCRP ≥2 mg/L randomised to canakinumab 150 mg every 3 months vs placebo, median follow-up 3.7 years.
- Primary endpoint (MI, stroke, CV death) reduced 15%, driven entirely by inflammation lowering — LDL was unchanged.
- Established that inflammation reduction is causal for cardiovascular events, not just a marker.
- Secondary finding: lung-cancer incidence reduced ~50% — remarkable signal in a primary cardiovascular trial.
Why it’s not used routinely
- Cost (~$70K+/year US list price).
- Fatal infection signal in CANTOS, primarily sepsis.
- Not approved for cardiovascular prevention indication.
- Cheaper alternatives (low-dose colchicine) cover much of the same biology.
Related entries
NLRP3 inflammasome, CANTOS, hsCRP, Chronic inflammation, Low-dose colchicine.
References
- Ridker, P. M. et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease (CANTOS). N. Engl. J. Med. 377, 1119–1131 (2017).