There were no significant differences in all cause or cardiovascular mortality, though the direction of the numbers favored canakinumab. However, canakinumab was associated with a significantly higher rate of fatal infection compared to placebo: 0.18 in the placebo group and 0.31, 0.28, and 0.34 in the 50, 150, and 300 mg canakinumab groups, respectively, all per 100 person-years. On the positive side, cancer mortality was lower in the canakinumab groups (see below for more on this).
"CANTOS has helped move the inflammatory hypothesis of coronary artery disease forward scientifically," wrote Bob Harrington (Stanford University), in an accompanying editorial in NEJM. "However, the modest absolute clinical benefit of canakinumab cannot justify its routine use in patients with previous myocardial infarction until we understand more about the efficacy and safety trade-offs and unless a price restructuring and formal cost-effectiveness evaluation supports it."