Deepak Bhatt, MD, MPH

TRANQUILITY: Pacibekitug Safely Lowers hs-CRP in ASCVD, With Deepak Bhatt, MD

The interleukin-6 (IL-6) inhibitor pacibekitug (TOUR006) has indicated its safety and efficacy in reducing high-sensitivity C-reactive protein (hs-CRP) levels in patients with 

atherosclerotic cardiovascular disease (ASCVD)

, based on results from the phase 2 TRANQUILITY trial.

American Heart Association’s Scientific Sessions 2025

 in New Orleans, Louisiana, by Deepak Bhatt, MD, director of the Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai.

Pacibekitug is an investigational long-acting fully human monoclonal antibody against the IL-6 cytokine, in development by Tourmaline Bio. While the TRANQUILITY trial investigated its efficacy in treating ASCVD, pacibekitug is also under development for thyroid eye disease, with plans to expand into abdominal aortic aneurysm in the future.

“We showed incremental benefit in hs-CRP reduction, and hopefully that will translate into cardiovascular event reduction,” Bhatt said in an exclusive interview with 

. “But this wasn’t a trial designed to measure cardiovascular events. TRANQUILITY was designed to look at safety and to look at hs-CRP, and it seemed to be safe and highly efficacious in reducing risk.”

Patients were included in the TRANQUILITY trial if they were ≥18 years old, had a serum hs-CRP level ≥2.0 mg/L and <15 mg/L, and a diagnosis of CKD. Patients were excluded if they exhibited evidence of active infection, had serious infections within 6 months or >1 episode within 18 months, a known history of immunodeficiency, a history of gastrointestinal ulceration or perforation within 12 months, a history of active diverticulitis, inflammatory bowel disease, or GI abscess within 12 months, among other criteria.

The treatment period lasted 6 months, followed by a follow-up period of an additional 6 months. The primary endpoint was median time-averaged percent change in hs-CRP through day 90, adjusting for baseline. The key secondary endpoint was the percentage of participants achieving time-averaged hs-CRP below 2 mg/L through day 90. Additionally, investigators noted the percentage of participants achieving hs-CRP reductions of ≥50%.

Bhatt and colleagues ultimately included 143 patients, stratifying them by CKD stage and randomly assigning them to receive either pacibekitug 25 mg quarterly, 50 mg quarterly, or 15 mg monthly, or placebo, all delivered subcutaneously. Median age was 71 years, and 62% of patients were women. Baseline estimated glomerular filtration rate and hs-CRP were 43 ml/min/1.73m2 and 4.45 mg/L, respectively.

By day 90, the median time-averaged percent reduction in hs-CRP was 86% for the 50 mg dose, 75% for the 25 mg dose, and 85% for the 15 mg dose, versus 15% for the placebo arm (all 

 <.0001). Several patients achieved hs-CRP reductions ≥50%, and the percentage of patients with hs-CRP <1 mg/L at day 90 was 60%, 45%, and 65% for the 50 mg, 25 mg, and 15 mg arms compared to 13% for placebo (all 

Bhatt and colleagues concluded that hs-CRP was reduced significantly across all prespecified groups with pacibekitug. They also observed significant reductions in serum amyloid A, fibrinogen, and lipoprotein(a). The incidence of adverse events was 54% and 56% in the pooled pacibekitug and placebo arms, respectively. The team noted similar findings for serious adverse events (10% vs 11%), infections (24% vs 22%), and serious infections (4% vs 3%). According to the study abstract, pacibekitug is now the first IL-6 inhibitor to demonstrate sustained and significant reductions in hs-CRP with quarterly dosing.

“Our hope is that, on the basis of the TRANQUILITY trial, there will be a phase 3 trial powered to look at cardiovascular end points,” Bhatt said. “That’s really what the purpose of the TRANQUILITY trial was: to see if it looked like the drug was safe, if it looked like there was an advantage potential over other IL-6 inhibitors, and to proceed with phase 3 testing.”

Pergola P, Szarek M, Zayed H, et al. A Phase 2 Multicenter, Randomized Double-Blind, Placebo-Controlled Study of Monthly or Quarterly Subcutaneous Administration of the Interleukin-6 Inhibitor Pacibekitug in Patients With Elevated High-Sensitivity C-Reactive Protein and Chronic Kidney Disease: 90-Day Analyses from TRANQUILITY. Abstract presented at the American Heart Association’s Scientific Sessions 2025. New Orleans, Louisiana. November 8-10, 2025.

Tourmaline Bio, Inc. A Study to Evaluate TOUR006 in Patients With Chronic Kidney Disease and Elevated Hs-CRP (TRANQUILITY). ClinicalTrials.gov Identifier: NCT06362759. Updated November 14, 2025. Accessed November 20, 2025. 

https://clinicaltrials.gov/study/NCT06362759

Mishek S. Tourmaline Bio Announces Positive Topline Results from the Ongoing Phase 2 TRANQUILITY Trial Evaluating Pacibekitug in Patients with Elevated High-Sensitivity C-reactive Protein and Chronic Kidney Disease. Tourmaline Bio. May 20, 2025. Accessed November 20, 2025. 

https://ir.tourmalinebio.com/news-releases/news-release-details/tourmaline-bio-announces-positive-topline-results-ongoing-phase

Videos

Bhatt discusses the positive results from the phase 2 trial of quarterly and monthly doses of investigational IL-6 inhibitor pacibekitug.

ACC 2025 Clinical Trials to Watch with Deepak Bhatt, MD, MPH, MBA

Few fields have experienced as much rapid advancement and transformation in recent years as cardiology. With groundbreaking insights into 

 mechanisms driving innovations in treatment, from novel lipid-lowering therapies to next-generation heart failure (HF) management and structural interventions, cardiologists must navigate a landscape of continuous breakthroughs that many specialties would equate to decades’ worth of progress.

These notable advancements in recent years continue to set the stage for the 

American College of Cardiology 74th Annual Scientific Session & Expo

. This year’s meeting, taking place in Chicago from March 29-31, boasts more than 4,750 accepted abstracts, with 1,300 expert faculty and 300 sessions, encompassing 53 late-breaking clinical trials.

A leading subject matter expert in cardiology, Deepak Bhatt, MD, MPH, MBA, director of the Mount Sinai Fuster Heart Hospital and the Dr. Valentin Fuster Professor of Cardiovascular Medicine at Icahn School of Medicine at Mount Sinai, is among the meeting’s planned attendees and presenters at this year’s ACC congress. For more insight into his perspective on this year’s meeting, the editorial team of HCPLive Cardiology spoke with Bhatt to learn what trials he was most looking forward to in Chicago.

Check out a rundown of Bhatt’s top 3 picks and when they are scheduled to be presented in our list below:

The Effect Of Once-weekly Subcutaneous Semaglutide On Functional Capacity In People With Type 2 Diabetes (T2D) And Peripheral Artery Disease (PAD): Primary Results From The Phase 3b, Randomized, Placebo-controlled, Double-Blind Stride Trial

: Saturday, March 29, 2025, from 09:50-10:02 AM CT

: STRIDE (NCT04560998) is a randomized, placebo-controlled, double-blind phase 3b trial evaluating 1 mg once-weekly subcutaneous semaglutide, a glucagon-like peptide 1 receptor agonist (GLP-1 RA) versus placebo, in people with symptomatic PAD (Fontaine IIa claudication) and T2D. Eligible participants were ≥18 years old, had hemodynamically stable PAD, had no planned intervention, and were not receiving a GLP-1 RA.

The primary endpoint is the change in maximum walking distance on a constant-load treadmill (CLT), with secondary endpoints including quality of life and cardiometabolic assessments. STRIDE will provide evidence on functional outcomes with semaglutide in people with PAD and T2D.

Oral Semaglutide Reduces Cardiovascular Events In People With Type 2 Diabetes With Atherosclerotic Cardiovascular And/or Chronic Kidney Disease: Primary Results From The SOUL Randomized Trial

: Saturday, March 29, 2025, from 1:30-1:40 PM CT

: SOUL is a multi-center, international, randomized, double-blind, parallel-group, placebo-controlled, phase 3 cardiovascular outcomes trial assessing the effect of once-daily oral semaglutide (Rybelsus) versus placebo on cardiovascular outcomes in 9650 people with T2D and established cardiovascular disease (CVD) and/or chronic kidney disease (CKD).

Headline results reported by Novo Nordisk found SOUL achieved its primary objective by demonstrating a statistically significant and superior reduction in major adverse cardiovascular events (MACE) of 14% with oral semaglutide treatment compared with placebo.

Dapagliflozin In Patients Undergoing Transcatheter Aortic Valve Implantation

Presentation Time: Saturday, March 29, 2025, from 2:15-2:25 PM CT

Presenter: Sergio Raposeiras Roubin, MD, PhD

: Patients undergoing transcatheter aortic valve implantation (TAVI) for aortic stenosis relief are at an elevated risk of developing heart failure (HF) within the first months of intervention. In the Dapagliflozin after Transcatheter Aortic Valve Implantation (DapaTAVI) trial, investigators sought to assess the clinical benefit and safety of dapagliflozin 10 mg/day on mortality and worsening HF in 1020 patients with severe AS undergoing TAVI

For the independent pragmatic, controlled, prospective, randomized, open-label blinded endpoint, multicenter trial in Spain, patients needed a prior history of HF admission plus diabetes mellitus, left ventricular ejection fraction (LVEF) ≤40%, or estimated glomerular filtration rate (eGFR) between 25 and 75 ml/min/1.73 m2.

Relevant disclosures for Bhatt include Amarin, AstraZeneca, Sanofi, Pfizer, Roche, Amgen, and Eli Lilly and Company, among others.

Bonaca MP, Catarig AM, Hansen Y, et al. Design and baseline characteristics of the STRIDE trial: evaluating semaglutide in people with symptomatic peripheral artery disease and type 2 diabetes. Eur Heart J Cardiovasc Pharmacother. 2025;10(8):728-737. doi:10.1093/ehjcvp/pvae071

Oral semaglutide demonstrates a 14% reduction in risk of major adverse cardiovascular events in adults with type 2 diabetes in the SOUL trial. Novo Nordisk. October 21, 2025. Accessed March 21, 2025. 

https://www.novonordisk.com/content/nncorp/global/en/news-and-media/news-and-ir-materials/news-details.html?id=171480

Amat-Santos IJ, Sánchez-Luna JP, Abu-Assi E, et al. Rationale and design of the Dapagliflozin after Transcatheter Aortic Valve Implantation (DapaTAVI) randomized trial. Eur J Heart Fail. 2022;24(3):581-588. doi:10.1002/ejhf.2370

Bhatt previews 3 late-breaking clinical trials being presented at this year's American College of Cardiology Annual Scientific Sessions.

This has been a great program. I’ve learned a lot. We covered lots of ground about antithrombotic therapy, coronary artery disease [CAD], and peripheral artery disease [PAD] in general. Let me turn to our distinguished panel for some closing thoughts. I’ll start with you, Manesh. Any final points [that] you want to make for the audience?

Deepak, it’s been fun and exciting. It’s fun to talk to people about evidence for the things we see. We’ve learned over the last decade is that vascular disease unfortunately is still the leading cause of cardiovascular mobility issues and mortality. As we have more options, which is a good thing, we have to get the right dose for the right patient at the right time. Some of that is understanding the risk and the risk benefits that we’ve talked about. Concerning patients with polyvascular disease, patients with broad thrombotic risk, it’s important to understand how you can make them have better outcomes. We’ve talked about that today. Hopefully it’s something that people will take home.

 I agree. It’s been a wonderful panel. I’m thrilled to be part of this. My take-home message would be to focus on identifying these polyvascular patients. Because they’re such high-risk patients, it’s important not to be focused on the coronary artery disease. But if patients have coronary artery disease and vascular disease in another territory, then that’s the pinnacle of our risk. Diabetes on top of that is going to be at that highest cardiovascular risk, so we need to talk with our patients about the fact that they’re at a higher risk and how that guides our recommendations for changing medications. Oftentimes patients can be resistant, understandably, to wanting to add another medication. But part of patient-centered decision-making is educating them that this is why that goes a long way.

We need to educate the medical community about those risks that identify polyvascular disease, diabetes is a real risk amplifier. Great points. Eric, any closing thoughts?

 This was a fantastic discussion. For everyone watching this, it’s important for us to not be fearful of making a change in our practice. We’ve been set in our ways for a long time, but we’ve had these accumulating data. It’s time for us to be open-minded about making changes that benefit our patients. We’ve heard today that there are many agents that can optimize long-term cardiovascular and limb-related risk outcomes and improve the care for our patients, so it was a great discussion.

Absolutely agree and Sahil, any final thoughts?

 That’s really important. What Eric just said is that we’ve been in this mode of using dual-antiplatelet therapy for extended amounts of time with very little evidence, particularly in the PAD population, which is the predominant part of my practice. It’s great that we have strong evidence to support the use of dual-pathway inhibition. We need to get the message out to our referring doctors and our patients that this is the way forward to optimize the risk.

Terrific. Marc, you’ll get the final word.

 It’s been an honor to be part of this panel. We’ve learned that we have a gap in terms of the evidence and how we treat our patients. Part of that is that we have a lot of patients to see. We’re all very busy clinicians. Everyone wants to do their best. But understanding who the highest-risk patient is and what the best evidence is needs to be at the top of your mind as you see your clinic patients, and polyvascular disease resonates. I learned that term from you, Deepak, many years ago. It has been shown in every study to be such a potent marker of risk and beneficial for some of these strategies and other things like diabetes. We need to take that into the clinic and start treating our patients better.

I couldn’t agree more. Hopefully the audience found this exchange of ideas informative, interesting, and educational. Hopefully these are things you can take this into your practices. As I mentioned, I learned a lot. A final point I’ll make is that when you’re thinking about coronary artery disease, think about the whole patient. For that patient you’re seeing for 1 specific condition, that might be the issue in the office for that day. But they may have other risk factors. They may have plaque in other arterial territories. We talked a lot in this session about polyvascular disease, but keep in mind that CAD, PAD, and cerebrovascular disease can coexist. Even though the patient might be seeing you for angina in that office visit or hospital encounter, think about all those associated risks. If you identify those associated risks, you realize that it’s a very high-risk patient, the sort of patient for whom we want to do everything possible to reduce their risk, including intense lifestyle modification. Beyond that, in many cases pharmacotherapy, polypharmacy with wisdom and caution, and in some cases procedural care are all complementary approaches, not competitive approaches.

Thanks to all of you on our panel and to our audience for this rich and informative discussion. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming 

 and other great content right in your in-box.

A panel of expert cardiologists share their concluding thoughts on management of polyvascular disease in clinical practice.  

Concluding Thoughts

Let’s move on to the final segment to see what our panel thinks are the latest and greatest things coming down the pike to treat high-risk patients and particularly patients with CAD [coronary artery disease] who are at high risk, patients with PAD [peripheral artery disease], patients with polyvascular disease. Manesh, I’ll start with you and work my way down the table. What are the big unmet needs, and what things—in terms of drugs, procedures, or lifestyle approaches—will target those unmet risks?

 That’s a great question. It’s something that we struggle with as we try to think about how we can eradicate atherosclerosis, especially as we think about the burden on our population and the health equity issues inherent that have been laid bare over the last several years with COVID-19 and other things. If I go back to my thinking about where we are with atherothrombosis, there are a few big opportunities. I said it was inflammatory atherothrombosis, so understanding that first part is important. There are strategies coming, but the biggest unmet need is on both the implementation side and the discovery side. On the implementation side, we have proved therapies that aren’t getting used.

The reason we’re having this conversation is we just talked about some therapies that might reduce mortality in cardiovascular disease. I’ll use the A-Fib [atrial fibrillation] example: 12 years ago, we presented the first DOAC [direct oral anticoagulant] data. This was the first year that more than 50% of people worldwide will get a DOAC. The amount of time it takes from something being proven to getting to our patients—I’ll call it the last mile—is probably where we should spend a lot of time.

What are the areas in the first mile? Concerning areas for discovery that are the biggest, we need to do screening studies. We’re at the point with CT scans and some other things that, instead of saying there’s an ASCVD [atherosclerotic cardiovascular disease] risk, we should be saying, “You have the disease. Here’s how much your plaque burden in the legs and the heart is, and here’s how I’m going to get you motivated.” Behavioral change starts with getting the person to have an emotional response—not a rational response, but an emotional response—to that issue.

A variety of things, whether it’s LP(a) [lipoprotein(a)] or other things, are going to change how we think of the biology of the plaque. Maybe the biggest discovery I see coming is how we think about diabetes. You’ve worked on this with others. There are agents that not only change your cardiovascular events but also reduce your weight and help you with diabetes. If you think about the global burden of those issues, those are the big areas.

Those are all good ones. Amy, you’re next. What’s coming down the pike?

 I agree wholeheartedly. Screening is critical. We know from the decisions about aspirin for primary prevention and shrinking the population, who gets treated with aspirin for primary prevention based on USPTSF [US Preventive Services Task Force] recommendation changes, you’re using a coronary calcium scan. It can help risk-stratify. To your point, we’re identifying patients who have atherosclerosis. We need to be doing the same thing in patients at increased cardiovascular risk and looking for PAD as well.

Marc brought up the PCSK9 inhibitors and more aggressive lipid lowering. It’s been too long of not treating our highest-risk patients aggressively enough if we have these tools at our disposal. We’re not talking with patients about why we need to use these. You brought up the importance of diet despite everything else we’re layering on: trying to address food deserts, access to healthy food, all of the social determinants of health. As a community, as we’re emerging from COVID-19 and start to be together again in communities, it’s going to be critical to find safe ways to have patients exercise and be active, such as walking trails.

The last thought is regarding the microvascular disease. One of my other hats is with women’s heart health, and microvascular disease has certainly been part of how we view women’s presentation with chronic symptoms or an acute coronary syndrome. We’re at the beginning of understanding microvascular disease with PAD. My final thought is we have this imprint in our minds of the heart, brain, leg connection—the 3 legs of the stool—if we’re going to treat patients’ cardiovascular risk aggressively.

You’ve made many different and good points. We’ll do a lot more as a community about microvascular disease. It will be primarily medical therapy based, but that’s going to be an area that’s ripe for further discovery. Marc, what’s exciting to you in terms of unmet needs, risks, and ways to address them?

 Thank you, Deepak. Those are great comments. We’ve had a lot of trouble being successful in implementing lifestyle change with our patients. You have 15 minutes with the patient. It’s hard enough to prescribe drugs, but lifestyle change is really hard to do when it’s every 6 months in the clinic. There are new digital therapeutics out there that are helping people with cognitive behavioral therapy and other ways that have shown improvements. You can have patients lower their own hemoglobin A1C [glycated hemoglobin] and other things through lifestyle change. That’s an exciting avenue to interact with our patients in the digital domain. That plays into what Manesh said about implementation science. We need to invest the same resources and study how to move the needle as we do in the refined experiments that show efficacy and safety of the drugs. I look forward to more implementation science.

In the therapeutic domain a lot of things have been said. With LP(a), there’s a real relationship with peripheral artery disease and some very bad events. There may be an exciting avenue for tailored therapy in those patients who have an elevated LP(a). Finally, we’re further decoupling ischemic risk and bleeding risk with our antithrombotics and broadening the utilization of antithrombotic therapies, in terms of those perceived as high bleeding risk or who are at high bleeding risk, to offer more avenues. When you look at patient selection things, it’s always hard to say, “What if you’re at a high bleeding risk?” If you use antiplatelet monotherapy, then that thrombotic risk that Manesh talked about remains unaddressed, so finding new therapies is important.

Those are all promising areas for the future. What do you think, Sahil? What do you put on your top 10 list?

 As a coronary and peripheral interventionalist, I think the most vexing thing is that we’ve known for a long time that the critical inpatient is the highest-risk patient that I ever treat, whether it’s a stent or any other intervention. For the last 4 decades, we’ve gotten better at revascularization, but we haven’t altered the mortality curve. It’s because of a lack of understanding that the systemic things that Eric alluded to are the problem: the patient’s diet, mind, and stroke. Even though we’re taking care of their legs, we need to take care of the whole patient. With low-dose rivaroxaban, we may have an arrow in the quiver, and we just need to use more to bend that curve. That’s what I hope for. That’s what we’ve been waiting for all this time.

There are other areas, though. It seems as if every other day there’s an article about SGLT2 inhibitors becoming a panacea for every cardiovascular ailment we see. The application of that is specifically looking in these high-risk populations, trying to see which arrows in the quiver are going to bend that mortality curve. That’s where the field is moving. Yes, we’ll be innovating new technologies for the specific treatments, but we’re just fixing potholes; we’re not fixing the highway. Until we get that infrastructure fixed, we’re not going to bend that mortality curve.

Both are important. You don’t want potholes on your drive to work, either. The potholes matter too, but the highway matters a lot as well. I totally agree. It’s always tougher going at the end of the panel because everyone has already said the good things already.

 I’m checking off everything I can’t say.

That’s why I’m giving you a couple of seconds. What’s on your list of things that are up and coming?

 We start the conversation with polyvascular disease. We haven’t spent a lot of time on polypharmacy. Concerning all the things we’ve discussed; the therapies don’t work if the patients don’t take them. We’ve seen this in hypertension. More than 50% of people don’t have hypertension under control. If you go from 2 hypertension agents to 3, you double your risk of nonadherence. We have some amazing therapies available, but we need to get our patients to take them. We’ve saw some great evidence last year on polypills—the renewal of the polypill. Maybe we should be tailoring some of our therapy, so that list of 10 medical regimens that our patients carry around in their pillboxes are 1, 2, or 3.

We’re also going to see more device-based treatments for other conditions, like hypertension. We’re talking about renal denervation as an option to limit the pill burden and use another mechanism of reducing a cardiovascular risk factor that has great long-term risks. Bringing it back to the patient, we can do a great job creating these therapies, but they don’t work if the patient doesn’t take them. We need to do a little better job of getting an adherent regimen that a patient can follow long term. Marc, that ties in to your comment on implementation science and bringing it from the clinic to the home.

Cardiologists share unmet needs and emerging approaches to management of patients with polyvascular disease.

Deepak Bhatt, MD, MPH

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