Oral Statins may Improve PASI Score in Patients With Severe Psoriasis
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Statin use was associated with improvement in Psoriasis Area and Severity Index score among patients with severe psoriasis, according to a recently published meta-analysis.
“Statins ... have immunomodulatory effects, which could be beneficial in psoriasis,” Mateusz Socha, MD, of the department of internal medicine and cardiology at the 1st Military Clinical Hospital, Lublin, Poland, and colleagues wrote. “In the skin, statins favor Th1-mediated immune responses, inhibit the induction of MHC II, prevent cytokine release from mast cells and mast cell degranulation, and inhibit interactions between pro-inflammatory chemokines.”
The researchers added that while statins also may improve cardiovascular risk in patients with psoriasis, the results of clinical trials assessing the impact of statins on psoriasis itself are inconsistent.
With this in mind, they conducted a meta-analysis of randomized controlled studies pertaining to the impact of statins on psoriasis severity. Two investigators performed independent searches of the PubMed, Embase, Cochrane and ClinicalTrials.gov databases for studies assessing patients using PASI as an outcome measure.
Studies from inception through February 2019 were eligible for analysis. They included patients who were aged 16 years and older and had 8 or more weeks of statin treatment.
The initial search yielded 279 records. Five randomized controlled trials involving 223 patients comprised the final analysis, with 128 of those patients receiving atorvastatin or simvastatin.
Results showed that patients who received statins experienced significantly greater PASI improvements than those who received placebo or other comparators (mean difference in PASI change = 2.76; P = .017).
However, subgroup analysis results revealed that simvastatin was associated with a significant improvement in PASI score (mean difference in PASI change = 3.70; P < .001), while atorvastatin was not (mean difference in PASI change = 2.30).
The researchers cautioned that only one of the five trials provided detailed information about how patients were randomized, and none included information about whether allocation concealment was performed.
“Oral statins may improve psoriasis, particularly in patients with severe disease,” the researchers said. “This observation should be verified in long-term, well-designed studies that will enable analyses adjusted for clinical variables.”
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Nehal N. Mehta, MD, MSCE, FAHA
This study provides an interesting path forward to understand whether lipid lowering therapy may benefit psoriasis itself. We know that improvement in cholesterol content in other tissues improves inflammatory response, and this may be true in the skin. However, the changes observed were small, unlikely clinically meaningful but do indeed support further efforts in testing this hypothesis in larger, prospective studies.
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