Is canakinumab really a wonder drug?
Alex Freeman

I’ve just been asked on Twitter whether anyone has compared the risks and benefits of canakinumab with those of aspirin. Good question!

Aspirin also has beneficial effects on cardiovascular risk and cancer risk, along with some risks associated with bleeding. And of course it’s very cheap.

I have just had a very quick look online for some comparable data about aspirin, and from a meta-analysis in the BMJ ( it appears that in patients who had had a heart attack (i.e. similar group to those in the canakinumab trial), long-term aspirin treatment has greater benefits in preventing heart attack, stroke or ‘vascular death’ than those seen with canakinumab. Looking at all causes of death in these patients, aspirin also significantly (p=0.02) reduces that too, over the time period of the studies:

The increased problem of bleeds accounted for about 3 extra bleeds per 1000 patients over the study period (or about 1 per 1000 per year).

I had a quick look to find data on aspirin’s cancer benefits, and they seem to be summarised in this paper in Lancet from 2011 ( which says:

“we showed that aspirin reduced risk of death due to cancer by about 20% in the trials, due mainly to a 34% reduction in cancer deaths after 5 years. By long-term post-trial follow-up of patients in three of these trials, we showed that the 20-year risk of cancer death remained about 20% lower in the aspirin groups, and that benefit increased with scheduled duration of treatment in the original trial.”

(Relative risks! Although the paper does cite some absolute figures too)

They also confirm:

“Our analyses show that taking aspirin daily for 5–10 years would reduce all-cause mortality (including any fatal bleeds) during that time by about 10% (relative risk reduction)”

Compared with the cheap and easy daily small dose of aspirin, then, canakinumab is looking even less ‘wonder’ful.

(Thank to Phil Donnelly-Rooney for the suggestion)

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