Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Pharmaceutics and Pharmacy Practice

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Modern Pharmaceutics Volume 7

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Modern pharmaceutics / edited by Gilbert S. Banker, Christopher T. Rhodes.

Includes bibliographical references and index.xi, 838 pages.

Examination of aqueous oxidized cellulose dispersions as a potential drug carrier: II. In vitro and in vivo evaluation of phenylpropanolamine release from microparticles and pellets

The purpose of this research is to investigate the release of phenylpropanolamine from oxidized cellulose-phenylpropanolamine (OC-PPA) complexes prepared using aqueous OC dispersions (degree of neutralization, DN, 0–0.44) and phenylpropanolamine-hydrochloride (PPA.HC1) (concentration, 0.5 M or 1.4 M) in vitro and in vivo. The results showed a faster drug release from the OC-PPA complex made using the OC dispersion with a DN value of 0.22 than from those prepared using dispersions with DN values of 0.29 to 0.44. No significant difference existed between the release profiles of OC-PPA microparticles made using OC dispersions with DN values of 0.29 to 0.44 OC-PPA complexes that contained smaller size particles or higher drug levels, or that were processed by freeze drying released PPA faster. Compared with microparticles, the pellets of OC-PPA complexes released PPA more slowly initially. An increase in pH or ionic strength of the dissolution medium increased the release of PPA, which is attributable to increased polymer hydration and solubilization at higher pH and ionic strength conditions. The OC-PPA pellets implanted subcutaneously in rats released 100% of their PPA in 9 to 12 hours. Agood correlation was found between the in vivo and in vitro release data. Tissue pathology results showed no significant inflammatory tissue reactions. In conclusion, the partially ionized aqueous OC dispersions have the potential to be used as an implantable biodegradable carrier for amine drugs