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Statin use reduces disease activity in AS

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CHICAGO — Statin use, in combination with NSAIDs, significantly reduced disease activity among patients with ankylosing spondylitis, according to data presented at the ACR/ARHP 2018 Annual Meeting.

During a presentation, Jonathan Dau, MD, third-year internal medicine resident at The University of Texas Health Science Center, Houston, said the findings build on earlier research demonstrating a benefit of statin use among patients with rheumatic diseases.

Previously, a large randomized clinical trial showed that high-intensity statins reduced disease activity scores, swollen joint counts, C-reactive protein (CRP) rates and erythrocyte sedimentation rates (ESR) among patients with rheumatoid arthritis. Another randomized controlled clinical trial assessing statin use in patients with AS — who have a 30% to 50% increased risk for adverse cardiovascular (CV) events vs. patients with RA — also demonstrated a significant reduction in ESR, CRP rates and LDL-cholesterol levels, but a non-statistically significant decrease in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) scores. Additional findings from a population-based cohort study revealed a survival benefit of statin use among patients with AS.

“Because of all of this evidence, I came to the hypothesis that statin usage probably reduces disease activity in AS,” Dau said.

To investigate this theory, Dau and colleagues examined data from the PSOAS trial, an observational cohort study assessing predictors in AS. Currently, 1,269 patients from five facilities in the United States (n = 4) and Australia (n = 1) are enrolled in PSOAS. Of these patients, 814 with at least 1 year of follow-up and who met Modified New York criteria for AS were included in the current analysis. The primary outcome was the impact of statin use on BASDAI. The analyses were adjusted for age, gender, ethnicity, education, smoking status, CV comorbidities, CRP, exercise, antihypertensive medication use, NSAID use and tumor necrosis factor inhibitor (TNFi) use.

During the trial, 85 patients were using either a low-intensity statin (n = 9), moderate-intensity stain (n = 65) or high-intensity stain (n = 11). These patients were more likely to be smokers and have diabetes, CV disease and hypertension.

Statin use alone did not significantly reduce BASDAI scores. However, an interaction analysis assessing the impact of NSAID use revealed an association between statin use, an NSAID index of 50% of greater and reduced disease activity. Specifically, there was a significant reduction in BASDAI scores among patients receiving an NSAID index of 50% or greater, as well as a low-intensity statin (adjusted rate ratio = 0.68; 95% CI, 95% CI, 0.57-0.81) or high-intensity statin (aRR = 0.82; 95% CI, 0.72-0.94) vs. those who were not receiving any statin. There was no association between an NSAID index of 50% or greater and moderate-intensity statin use; an NSAID index less than 50% and any statin use; or no NSAID use and any statin use.

In contrast, when testing the interactions of statin and TNFi use, there was no significant difference in BASDAI scores among patients receiving a TNFi and statin vs. those receiving a TNFi alone. However, patients who were not receiving TNFis but were receiving high-intensity statins had significantly lower BASDAI scores than patients who were not receiving either medication. Dau said the findings suggest that “TNFis may mask the anti-inflammatory effect of statins.”

“In conclusion, statins, when taken with NSAIDs at anti-inflammatory doses, were associated with a significant reduction in AS disease activity,” he said. “Future studies will require more patients to confirm this effect.” – by Stephanie Viguers

References:

Dau J, et al. Abstract 895. Presented at: ACR/ARHP Annual Meeting, Oct. 20-24, 2018; Chicago.

Eriksson JK, et al. Ann Rheum Dis. 2016;doi:10.1136/annrheumdis-2016-209315.

McCarey DW, et al. Lancet. 2004;doi:10.1016/S0140-6736(04)16449-0.

Oza A, et al. BMJ. 2017;doi:10.1136/annrheumdis-2017-211253.

van Denderen JC, et al. BMJ. 2006;doi:10.1136/ard.2005.044503.

Disclosures: Dau reports no relevant financial disclosures.