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Dall’ Esc studi per nuovi farmaci che tutelano la salute del cuore

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Al congresso della European Society of Cardiology di Barcellona, è stato presentato uno studio sull’efficacia di un nuovo farmaco per la salute del cuore.

Il medicinale in questione è una molecola chiamata canakinumab, un anticorpo monoclonale, già impiegato nel trattamento di malattie autoimmuni come l’artrite reumatoide.

Lo studio, sponsorizzato dalla Novartis, ha dimostrato che tale molecola è in grado di ridurre la probabilità di un secondo infarto in chi ne ha già avuto uno grazie alla sua azione antinfiammatoria.

Circa diecimila pazienti di 39 Paesi in tutto il mondo, ad alto rischio perché già colpiti da infarto e con livelli elevati degli indici di infiammazione, hanno ricevuto la terapia standard, ovvero statine per abbassare il colesterolo, oppure, in aggiunta, un’iniezione a cadenza trimestrale di varie dosi dell’anticorpo canakinumab.

A quattro anni di distanza, tra coloro che avevano ricevuto anche il nuovo farmaco, c’è stata una riduzione di circa il 15 % dei casi di infarto e ictus. In particolare, l’effetto è stato maggiore tra coloro che avevano assunto la dose intermedia del medicinale.

Per anni si è accusato il colesterolo “cattivo” di essere la prima causa di aumento del rischio di infarti, ma da tempo si ritiene che a incidere nelle malattie cardiache sia anche l’eccesso di infiammazione, segnalato dalla presenza nell’organismo di molecole come la proteina C reattiva.

“Lo studio Contas ha dimostrato per la prima volta in modo deciso che l’infiammazione ha un ruolo importante nell’infarto” osserva Aldo Maggioni, direttore del Centro Studi Anmco. “Confermando tra l’altro l’ipotesi di Attilio Maseri, uno dei primi cardiologi a sottolineare il ruolo dei processi infiammatori nelle malattie cardiache”.

“Il farmaco canakinumab è particolarmente costoso, ha degli effetti collaterali non trascurabili, dovuti al fatto che agisce sul sistema immunitario, e probabilmente è adatto per un numero ristretto di pazienti” osserva Maggioni.

Ma la strada sembra segnata per far entrare nella pratica clinica farmaci che aiutino il cuore prevenendo l’infiammazione.

Un’alternativa low-cost che si sta sperimentando in un trial clinico di cui si dovrebbero avere i risultati entro due anni è la colchicina, un vecchio farmaco usato contro la gotta, che ha anch’esso proprietà antinfiammatorie.

“Si può dire che il 2017 è stato l’anno della prevenzione secondaria . Erano anni che non comparivano studi con dati favorevoli per nuovi farmaci” dice Maggioni.

Il trial clinico Compass, ad esempio, ha dimostrato che l’assunzione di un farmaco anticoagulante insieme all’aspirina riduce le morti per infarto di pazienti con patologie delle coronarie.

E in un terzo studio, il farmaco anacetrapib, oltre a raddoppiare il colesterolo “buono”, ha prodotto anche una riduzione della mortalità del 10 %.

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