At the 2025 Peking University Diabetes Forum & Coastal Long Bridge Symposium on Metabolic Diseases (Season 1, Quanzhou), Dr. Lin Chu of Peking University People’s Hospital emphasized that anti-inflammatory therapy carries important clinical value. However, it should not be used as an isolated intervention. Instead, it should be deeply integrated with standard treatments such as glucose-lowering, antihypertensive, lipid-lowering, and antiplatelet therapies. Through multidimensional combined interventions, it can provide more comprehensive “cardiorenal-metabolic” integrated protection for patients with CKM syndrome. This aims to further clarify the evidence-based practice and clinical value of anti-inflammatory therapy.
At present, the main clinical evidence for anti-inflammatory therapy in the CKM field still comes from cardiovascular research. The exploration of anti-inflammatory strategies in cardiology has not been smooth and has experienced many setbacks.
Currently, anti-inflammatory therapies mainly target two major pathways:The first category consists of inflammatory pathways dominated by IL‑1β/IL‑6, which involve the NLRP3 inflammasome and key inflammatory factors including IL‑1β, IL‑6, and TNF‑α. This class of pathways is supported by relatively robust evidence.
Canakinumab, which targets IL‑1β, is a representative drug. In the Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS) published in 2017, canakinumab significantly reduced the risk of major adverse cardiovascular events compared with placebo, confirming the feasibility and efficacy of targeting this pathway.
The second category includes alternative inflammatory pathways, among which the well‑known target is phospholipase A2 (PLA2), which plays an important role in atherosclerosis‑related inflammation. Related inhibitors were developed, but two agents failed to meet their expected clinical endpoints, representing a “Waterloo” in anti-inflammatory drug development.
Anti-inflammatory therapy is gradually entering clinical practice, and more clinical evidence is expected to further support its application in the future.
Overall, the future of anti-inflammatory therapy is progressing “through twists and turns”: it has extremely broad clinical prospects, but the path of exploration is inevitably full of challenges. The core reason lies in the extreme complexity of inflammatory pathways. In different cardiovascular, renal, and metabolic diseases, the core inflammatory drivers may differ, and may even be synergistically driven by multiple intersecting pathways.
Therefore, future research should focus on two directions:First, precisely identify the core disease‑driving factors of each disorder to provide a scientific basis for targeted intervention.Second, promote the upgrading of therapeutic strategies, shifting from single‑pathway regulation to combined multi‑target regulation, and expanding from monotherapy to combination or adjuvant therapy, to further enhance the clinical benefits of anti-inflammatory interventions.
The current challenges of anti-inflammatory therapy mainly lie in three aspects:First, innovative drugs such as canakinumab are expensive and unaffordable for many patients. Their accessibility is also limited by regional disparities in medical resources, and their widespread promotion requires more health economic evidence.Second, anti-inflammatory therapy may carry safety risks such as infection, requiring careful evaluation and monitoring based on individual patient conditions in clinical practice.Third, the inflammatory mechanisms driving different diseases have not been fully clarified, and the implementation of precision targeted therapy still needs more basic and clinical research.
Metabolic drugs such as GLP‑1 RAs and SGLT2is have been proven to exert cardiorenal protective effects independent of glucose lowering and weight reduction. These benefits are likely related to the anti-inflammatory properties of the drugs, suggesting great potential for “cross‑indication” applications.
In the future, we expect more such safe, affordable, and evidence‑based agents with clear cardiorenal benefits to enter clinical practice. On the basis of existing standard treatments, they will further reduce the risk of adverse cardiovascular and renal events in patients with CKM syndrome and bring more comprehensive health benefits.