No benefit of methotrexate on the risk of cardiovascular events

Access through your institution Buy or subscribe In the CANTOS trial, anti-inflammatory therapy with canakinumab, a monoclonal antibody that selectively neutralizes IL-1β, reduced the rate

of major adverse cardiovascular events in patients with stable coronary disease. By contrast, the findings of the CIRT trial, presented at the 2018 AHA Scientific Sessions by Paul Ridker,

the lead investigator of both studies, showed that low-dose methotrexate, a drug used to treat inflammatory conditions such as rheumatoid arthritis, did not reduce adverse cardiovascular

events in patients with stable atherosclerosis who were at high cardiovascular risk. Despite a neutral outcome, the CIRT trial provides additional information on designing future therapeutic

strategies for these patients. Differences in the design of the CIRT and the CANTOS trials and in the properties of the two anti-inflammatory drugs could explain the contrasting results

between the trials. Patients with stable atherosclerosis at high cardiovascular risk were enrolled in both trials, but the inclusion criteria for the CANTOS trial also included elevated

plasma levels of C-reactive protein (CRP). Median baseline CRP levels among the participants of the CANTOS trial were 4.2 mg/l, compared with 1.6 mg/l in the CIRT trial, which indicates that

patients in the CANTOS trial had a higher residual inflammatory risk. This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your institution

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REFERENCES ORIGINAL ARTICLE * Ridker, P. M. et al. Low-dose methotrexate for the prevention of atherosclerotic events. _N. Engl. J. Med._ https://doi.org/10.1056/NEJMoa1809798 (2018) Article

  PubMed  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Nature Reviews Cardiology http://www.nature.com/nrcardio/ Alexandra Le Bras Authors * Alexandra Le

Bras View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Alexandra Le Bras. RIGHTS AND PERMISSIONS Reprints and

permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Le Bras, A. No benefit of methotrexate on the risk of cardiovascular events. _Nat Rev Cardiol_ 16, 2–3 (2019).

https://doi.org/10.1038/s41569-018-0133-6 Download citation * Published: 28 November 2018 * Issue Date: January 2019 * DOI: https://doi.org/10.1038/s41569-018-0133-6 SHARE THIS ARTICLE

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