title: Statins are associated with reduced use of steroids in inflammatory bowel disease: a retrospective cohort study.
abstract: BACKGROUND
  Statin medications have antiinflammatory effects. We sought to determine whether statin use in persons with inflammatory bowel disease (IBD) was associated with reduced rates of steroid use or other markers of disease activity.
  
  
  METHODS
  We performed a retrospective cohort study using administrative data. Statin users with IBD were compared to statin-unexposed IBD subjects. The primary outcome was an oral steroid prescription; secondary outcomes included anti-tumor necrosis factor (TNF) initiation, hospitalization, or abdominal surgery. Cox proportional hazard models were used to estimate hazard ratios (HRs) adjusted for potential confounders.
  
  
  RESULTS
  The study cohort included 1986 statin-exposed and 9871 unexposed subjects. Statin use was associated with an 18% reduction in the rate of steroid initiation (HR 0.82, 95% confidence interval [CI] 0.71, 0.94). A statistically significant result was seen with atorvastatin only (HR 0.76, 95% CI 0.60, 0.96). Statins were associated with a reduced rate of steroids in ulcerative colitis (HR 0.75, 95% CI 0.62, 0.91), but not in Crohn's disease (HR 0.91, 95% CI 0.74, 1.12). Statin use was associated with reduced hazard of anti-TNF use (HR 0.72, 95% CI 0.46, 1.11), abdominal surgery (HR 0.80, 95% CI 0.63, 1.02), and hospitalization (HR 0.88, 95% CI 0.74, 1.05), but these results did not reach statistical significance.
  
  
  CONCLUSIONS
  In this large retrospective cohort study, statin use among persons with IBD was associated with reduced use of oral steroids, particularly for ulcerative colitis. Prospective clinical trials are needed to confirm whether adjuvant treatment of IBD with statin drugs may spare immunosuppressant therapy or ameliorate flares.
authors.affiliation: Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599, USA. sethc@med.unc.edu
authors.forename: Seth D
authors.initials: SD
authors.lastname: Crockett
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hansen
authors.forename: Til
authors.initials: T
authors.lastname: Stürmer
authors.forename: Robin
authors.initials: R
authors.lastname: Schectman
authors.forename: Jane
authors.initials: J
authors.lastname: Darter
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kappelman
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007166:Immunosuppressive Agents