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Statin discontinuation safe for patients with life-limiting illnesses
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In terminally ill patients, the discontinuation of statin medication appears to be safe, cost-effective and may be beneficial to quality of life, according to recent findings.
Moreover, in these patients, statin discontinuation allows for the minimization of nonstatin medication use and associated costs, the researchers wrote.
For a multicenter, parallel-group, unmasked clinical trial, researchers evaluated 381 terminally ill patients aged older than 18 years, with life expectancies of 1 month to 1 year. Eligible patients also were on a statin regimen for at least 3 months for prevention of CVD and had recent declines in functional status. The mean age of the patients was 74 years, 58% had CVD, 48.8% had cancer and 22% had cognitive impairment.
The researchers randomly assigned patients to continue (n = 192) or cease statin therapy (n = 189), with weekly follow-up for the first month, then on a monthly basis for up to 1 year.
The primary endpoint was death within 60 days. Other endpoints included survival, time to CV events, performance status, quality of life, symptoms, the number of nonstatin medications and cost savings.
Overall, the cohort had a mean survival of 213 days. The researchers observed no significant difference in 60-day mortality between patients who continued vs. discontinued statin therapy (23.8% in the discontinuation group vs. 20.3% in the continuation group; 90% CI, –3.5 to 10.5), and this difference did not meet the criteria for noninferiority.
The discontinuation group had better total quality of life, as indicated by the McGill Quality of Life Questionnaire (mean McGill score, 7.11) vs. the continuation group (6.85; P = .04). However, statin discontinuation did not have a significant impact on physical symptoms as measured by the Edmonton Symptom Assessment System scale. CV events were infrequent in both groups (13 in the discontinuation group vs. 11 in the continuation group), and the groups did not differ with regard to time to first event (P = .64). The mean cost savings of discontinuation were $3.37 per day, or a mean of and $716.46 per patient.
“This study provides evidence that suggests that survival is not affected when statins prescribed for primary or secondary prevention of CVD are discontinued in this population,” the researchers wrote. “Although the cost savings identified were modest, the data suggest that statin therapy discontinuation in selected patients may improve [quality of life] at reduced aggregate health care cost.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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