Statins, fibrates, and melanoma risk: a systematic review and meta-analysis.
BACKGROUND
Large randomized, controlled clinical trials of lovastatin and gemfibrozil for heart disease prevention have reported statistically significantly lower melanoma incidences in persons receiving these medications. Results of in vitro animal model and human case-control studies also suggest that statins and fibrates may reduce the risk of melanoma.


METHODS
We performed a systematic review of trials that randomly assigned participants to receive statins or fibrates versus an alternative therapy for a minimum of 6 months. Trials were identified by searching five electronic databases and the reference lists of eligible publications. Unpublished data were solicited from trial investigators and pharmaceutical companies. A meta-analysis was performed using a fixed-effects model, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to estimate pooled treatment effects. All statistical tests were two-sided.


RESULTS
We obtained data on incident melanomas from 20 of 36 qualifying randomized controlled trials (12 statin trials and eight fibrate trials), with a total of 70,820 participants. A total of 127 melanomas occurred among the 39,426 participants in the statin trials (59 among the 19,872 statin group participants and 68 among the 19,554 control group participants). A total of 27 melanomas occurred among the 31,394 participants enrolled in the fibrate trials (seven among the 12,324 fibrate group participants and 20 among the 19,070 control group participants). Overall, incidence of melanoma was not statistically significantly associated with the use of either statins (OR = 0.87, 95% CI = 0.61 to 1.23) or fibrates (OR = 0.45, 95% CI = 0.20 to 1.01). In a subgroup analysis by drug, only lovastatin use (in one trial) was statistically significantly associated with lower incidence of melanoma (OR = 0.52, 95% CI = 0.27 to 0.99).


CONCLUSIONS
These findings do not validate the possibility that statins or fibrates prevent melanoma.
Freeman
Scott R
SR
Department of Dermatology, University of Colorado at Denver and Health Sciences Center, Aurora, CO, USA.
Drake
Amanda L
AL
Heilig
Lauren F
LF
Graber
Marla
M
McNealy
Kristie
K
Schilling
Lisa M
LM
Dellavalle
Robert P
RP
D000069059:Atorvastatin; D001629:Bezafibrate / Q000627:therapeutic use; D002994:Clofibrate / Q000627:therapeutic use; D015248:Gemfibrozil / Q000627:therapeutic use; D006538:Heptanoic Acids / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D015994:Incidence; D008148:Lovastatin / Q000627:therapeutic use; D008545:Melanoma / Q000453:epidemiology / Q000517:prevention & control*; D016017:Odds Ratio; D017035:Pravastatin / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D019821:Simvastatin / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology
D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D011758:Pyrroles; D008148:Lovastatin; D000069059:Atorvastatin; D019821:Simvastatin; D002994:Clofibrate; D017035:Pravastatin; D015248:Gemfibrozil; D001629:Bezafibrate