Immune-Targeting Therapy with Aldesleukin: A New Frontier in Post-MI Care

IVORY trials show low-dose aldesleukin after acute myocardial infarction reduced vascular inflammation by an average of nearly 8% on imaging and blood markers — a targeted signal in a defined post‑MI subgroup.

IVORY trials tested low‑dose aldesleukin after acute MI and demonstrated this consistent anti‑inflammatory signal, suggesting a biomarker‑driven strategy for follow‑on studies.

Efficacy data derive from randomized cohorts with prespecified endpoints focused on vascular inflammation by imaging and corroborated by systemic inflammatory biomarkers. The overall mean effect was an ~8% reduction, concentrated in patients with the highest baseline inflammation — a clear interaction between baseline biomarker burden and treatment response that supports biomarker‑guided enrollment in confirmatory trials.

Safety signals were reassuring: tolerability was favorable with no new safety concerns. In the reported follow‑up, aldesleukin therapy–treated patients had no recurrent myocardial infarctions over two years, versus an observed recurrence rate of ~11% in the comparator arm. Adverse events were generally mild and consistent with expected immunomodulatory effects; these findings support additional study but do not yet establish long‑term outcome benefit.

Biomarker analyses identified the patients most likely to respond: higher baseline vascular inflammation on imaging and elevated systemic inflammatory markers predicted larger absolute reductions. A practical selection approach is to identify post‑MI patients with persistently elevated inflammatory biomarkers despite optimized secondary prevention and prioritize them for enrollment and close monitoring in next‑phase trials, using biomarkers both to measure efficacy and to guide recruitment.

Key Takeaways:

• Low‑dose aldesleukin produced a near 8% mean reduction in vascular inflammation on imaging and biomarkers, with the effect concentrated in those with high baseline inflammation.
• Post‑MI patients who have persistently elevated inflammatory biomarkers despite optimized secondary prevention are the most likely subgroup to benefit and should be the focus of future confirmatory studies.
• These data prioritize biomarker stratification and larger randomized outcome trials to confirm clinical‑event benefits and to refine enrollment criteria for follow‑up studies.