Statins may protect against acute cholangitis in primary sclerosing cholangitis

SAN DIEGO — Statin therapy decreased the risk for developing acute cholangitis among patients with primary sclerosing cholangitis, according to research presented at Digestive Disease Week 2022.

“Primary sclerosing cholangitis [PSC] is a cholestatic biliary disease whose analysis and underlying biology remains fairly poorly understood,” Chiraag Kulkarni, MD, internal medicine specialist at Stanford University, said. “The complications of PSC are the development of acute cholecystitis, significantly elevated risk for GI malignancy and the development of cirrhosis, and approximately a third of patients with PSC ultimately develop acute cholecystitis and infection with significant morbidity and some mortality. We have very limited epidemiologic data regarding the risk factors for acute cholecystitis in patients with PSC.”

In a multicenter, retrospective cohort study, Kulkarni and colleagues analyzed 294 patients with PSC at Stanford Medical Center, Baylor University Medical Center and Santa Clara Valley Medical Center. Researchers collected data on patient demographics, medications, PSC disease severity and IBD disease status and assessed risk factors for cholangitis. They also evaluated the impact of medications that affect bile acid metabolism on cholangitis development. Kulkarni noted that acute PSC in this study was defined as diagnosis by clinical judgement.

According to study results, 30% of patients had at least one episode of acute cholangitis. Bile acid sequestrant use associated with an increased risk for acute cholangitis (OR = 4.91; 95% CI, 2.05-12.37) while statin therapy associated with a decreased risk (OR = 0.22; 95% CI, 0.07-0.62). In addition, statin use correlated with an increased time-to-cholangitis at 36 months compared with patients not on statin therapy (incidence: 8.6% vs. 51.6%).

“Statin therapy is associated with significantly decreased odds of cholangitis and increased time-to-event. ... Bile acid sequestrants, which are also lipid lowering drugs, are associated with significantly increased odds of cholangitis and this likely occurs in a vitamin D-independent manner,” Kulkarni concluded. “These findings extend previous work which show that statins are associated with increased transplant-free survival in these patients, suggesting that there is probably significant overall benefit.”