Is there an anti-inflammatory effect of statins in rheumatoid arthritis? Analysis of a large routinely collected claims database.
BACKGROUND
* The increasing evidence of the anti-inflammatory action of statins has stimulated interest in whether these might be beneficial in disease management of rheumatoid arthritis (RA), a chronic diseases characterized by high levels of inflammation. * The TARA trial (McCarey 2004) suggested a significant reduction in disease activity outcomes in RA patients randomized to atorvastatin compared with those assigned to the placebo harm. * However, as the signal reported by the trial was small, more evidence is needed.


CONCLUSIONS
* We investigated the possible anti-inflammatory effect of statins in a cohort of RA patients using a large health insurance claims database. * To our knowledge, this is the largest study ever conducted on the anti-inflammatory effects of statins. * Our data do not show any beneficial effect of statins in reducing disease inflammation in RA patients.


OBJECTIVE
To investigate the possible anti-inflammatory effect of statins in a cohort of rheumatoid arthritis (RA) patients.


METHODS
We conducted a cohort study consisting of all patients with at least one claim for RA using LifeLink, a health insurance claims database. Initiation and cessation of oral steroid (OS) therapy were treated as surrogate for inflammatory flare-up and controlled inflammation, respectively. We split the RA patients into two sub-cohorts based on whether they were using OS within a specified time window of the RA index date (first recorded claim for RA in the database). Cox proportional hazard models were used to evaluate the association between time-varying exposure to any statins and (i) initiation of OS therapy in the non-users of OS at RA index date and (ii) cessation of OS therapy in the users of OS at RA index date controlling for potential confounders.


RESULTS
We found 31 451 non-users of OS at RA index date and 6026 users of OS within the time window at RA index date. The results on both sub-cohorts were both consistent with no association of statin exposure with the risk of initiation/cessation of OS: the hazard ratio (HR) of initiating OS therapy was 0.96 (95% confidence interval 0.9, 1.01) in the sub-cohort of non-users and the HR of cessation of OS therapy was 0.95 (0.87, 1.05) in the sub-cohort of users of OS therapy at RA diagnosis.


CONCLUSIONS
These data do not show any beneficial effect of statins in reducing disease inflammation in RA patients.
Lodi
Sara
S
London School of Hygiene and Tropical Medicine, London, UK. sal@ctu.mrc.ac.uk
Evans
Stephen J W
SJ
Egger
Peter
P
Carpenter
James
J
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007249:Inflammation / Q000188:drug therapy*; D016015:Logistic Models; D016016:Proportional Hazards Models
D000893:Anti-Inflammatory Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors