Researchers Found Something They Were Not Looking For
The main focus of study was to observe the relationship between canakinumab (Ilaris) and heart disease. Analysis of data from the CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study), a randomized, double-blind, placebo-controlled trial, has already produced some startling numbers: Ten thousand patients with elevated high-sensitivity C-reactive protein (hs-CRP) levels and a history of myocardial infarction received the drug canakinumab, an interleukin-1 beta (IL-1β) inhibitor, or placebo via injections every three months for almost five years to determine the cardiovascular effects. IL-1β is a mediator of the inflammatory response. As reported in the New England Journal of Medicine in September 2017, cardiovascular events did decrease in those receiving canakinumab. The biggest effect was seen by those who had the most reduction in hs-CRP, a protein that measures general levels of inflammation in your body. RELATED: What Does Arthritis Pain Feel Like?
Results Provide Important Data About OA and Joint Replacements
In a newer study, published on August 2, 2020, in Annals of Internal Medicine, CANTOS has also provided big news for osteoarthritis therapy. Previous research showed a relationship between OA and hs-CRP. The new trial recorded every trip by one of the subjects to the hospital for surgery, and received very detailed records of joint replacements. The results were clear: The combined incidence rates for total hip or total knee replacements were 40 to 47 percent lower with canakinumab treatment, with all canakinumab doses reducing the number of joint replacements at the same level. This percentage held steady even after researchers excluded data about patients with a history of crystalline or inflammatory arthritis such as gout, already known to respond to canakinumab. “The main CANTOS trial was designed to address whether IL-1β can reduce heart attack and stroke, which it did. In that setting, elevated hs-CRP defines a patient population with residual inflammatory risk. It is possible that this is also why the drug worked for OA,” says the study coauthor Paul M. Ridker, MD, a senior physician at the center for cardiovascular disease prevention at Brigham and Women’s Hospital in Boston and a professor of medicine at Harvard Medical School.
The OA Community Is Intrigued by the Results
The reduction in joint replacements among participants who received canakinumab appeared after only a year of regular treatment. “The study demonstrates a novel method to reduce by over 40 percent the need for hip or knee replacements among patients who are suffering from osteoarthritis,” says Dr. Ridker, adding, “If future research confirms these findings, patients can be optimistic that new targeted anti-inflammatory therapies will be on the horizon. Our current data should provide optimism to patients and spur industry to find novel ways to treat and prevent OA.” RELATED: How Massage Therapy Helps Relieve Osteoarthritis Pain
Doctors Can Treat OA Symptoms; They Can’t Stop the Disease
Drugs, physical therapy, and other approaches can help relieve pain and other OA symptoms, but these treatments cannot stop the disease itself. Nancy E. Lane, MD, an endowed professor of medicine, rheumatology, and aging research and the director of the center for musculoskeletal health at the University of California in Davis, who was not involved in the research, wrote an editorial about the study. “We’ve never had a study in osteoarthritis that has this dramatic of an effect in reducing the number of joint replacements. This is an observation unlike anything we’ve ever seen before,” she told Everyday Health, adding, “If we can confirm these observations, then we have a way to significantly reduce the number of people who need joint replacements. The results are really exciting.” RELATED: I Tried HoMedics ParaSpa Plus Paraffin Bath for My Arthritis — and It Really Helped
More Research Is Needed to Confirm OA Benefits
This was a secondary data analysis, and not the primary outcome of the CANTOS study. “Hopefully, a study will now be done to see if inhibitors of interleukin 1 will reduce knee and hip replacements in study subjects recruited into the study with a definite diagnosis of knee or hip OA,” says Dr. Lane. These future studies will determine if the intervention was effective because it reduced the progression of the OA determined X-rays or it worked by reducing joint pain, or both. RELATED: The Possible Benefits of Metformin for Type 2 Diabetes and Other Health Conditions
Possible Side Effects of Canakinumab
Targeted anti-inflammatory drugs like canakinumab do carry a risk of infections, as discussed in the August 2018 issue of European Heart Journal, such as sepsis, cellulitis, and pneumonia.
Future Study Needs to Focus More on Women
Data on small joints was not reported because the end point looked only at knee and hip replacements. One shortcoming of the study was that because its main focus was on men and heart disease, there was a low number of women in the trial. Older women tend to have a higher incidence of knee osteoarthritis. “Future study is needed to reflect the general OA population,” says Ridker. RELATED: 10 Minutes of Walking a Day Can Be a Game-Changer for People With OA
