Concomitant statin therapy yields benefit on IPF progression

Statin therapy may have a significant benefit on progression of idiopathic pulmonary fibrosis, according to results of a retrospective study published in Respiratory Medicine.

“To reduce their cardiovascular risk, many IPF patients receive statins treating hypercholesterolemia. In the past 2 decades, there had been controversy whether statin would induce interstitial lung disease,” Eline M. Lambert, MD, from the department of respiratory medicine at the University Hospitals Leuven, Belgium, and colleagues wrote. “We investigated the correlation between IPF and cardiovascular comorbidities by analyzing the impact of prescribed drugs on pulmonary function and survival.”

Researchers reviewed the database of a tertiary referral center for ILDs in Belgium for statin, antiaggregant, anticoagulant and metformin therapy use. Researchers assessed percentage of predicted FVC (FVC%) and diffusion capacity of the lung for carbon dioxide trajectories along with survival as outcome measurements over a 4-year study period.

The retrospective study included 323 patients (mean age, 70.8 years; 76.5% men) with IPF. Of those, 45% had at least one CV comorbidity. Antifibrotic therapy was used in 86%. CV drug use included statins (n = 171), antiaggregant therapy (n = 152), anticoagulation therapy (n = 49) and metformin therapy (n = 28). Of those using statins, the most common therapies were atorvastatin (n = 66), simvastatin (n = 52), rosuvastatin (n = 36), pravastatin (n = 16) and fluvastatin (n = 1).

Statin users, compared with nonusers, demonstrated slower annual FVC% (difference, 2.9%; 95% CI, 1.6-4.4; P < .001) and diffusion capacity of the lung for carbon dioxide decline (difference, 1.3%; 95% CI, 0.24-2.3; P = .013).

Among patients on antiaggregant therapy, researchers observed a trend toward slower FVC decline (P = .098) and a numerical decrease in survival (HR = 1.63; P = .074) compared with those not on antiaggregant therapy.

Among patients on anticoagulant therapy, the researchers reported a trend toward worse diffusion capacity of the lung for carbon dioxide decline (difference, –1.3%; 95% CI, –2.6 to 0.02; P = .055) compared with those not on anticoagulant therapy.

There was no effect on IPF progression in terms of pulmonary function test evolution or survival among patients on metformin therapy, according to the results.

The researchers noted several limitations of this study, including its retrospective, single-center design.

“In this large retrospective study, we provided evidence supporting a potential beneficial effect of statin therapy on IPF evolution, demonstrated by a significantly slower FVC and [diffusion capacity of the lung for carbon dioxide] decline,” the researchers wrote. “As opposed to previous recommendations, there is no evidence to discontinue statin therapy in IPF patients. Our data even suggest a benefit of statin therapy in disease progression.”