Statins significantly reduced C reactive protein (CRP) and interleukin-6 (IL-6) compared with placebo in patients with chronic obstructive pulmonary disease (COPD), but did not translate into a clinical benefit, according to a review published in the Cochrane Database of Systematic Reviews.
In this review, researchers identified 8 parallel, randomized controlled trials recruiting adults aged ≥18 years with stable and unstable COPD (N=1323) from the Cochrane Airways Trials Register through May 20, 2019. To determine whether statins reduced mortality rates or exacerbation frequency, researchers included trials comparing any statin at any dose vs placebo given for ≥12 weeks. Primary outcome measures were the number of exacerbations, all-cause mortality, and COPD-specific mortality.
The duration of treatment with statins ranged from 12 weeks to 36 months. A significant “slight reduction” in CRP was observed in 3 studies (mean difference [MD], -1.03; 95% CI, -1.95 to -0.11; P =.003; n=142). Likewise, 2 studies reported a significant reduction in IL-6 (MD, -2.11; 95% CI, -2.65 to -1.56; P ≥.00001; n=125). However, there was no statistically significant difference in the number of exacerbations between statins and placebo in the 1 trial to report specific detail on exacerbations (MD, -0.03; 95% CI, -0.25 to 0.19; P =.54; n=877).
In addition, there was no statistically significant difference between statins and placebo for all-cause mortality in 2 trials (odds ratio [OR], 1.03; 95% CI, 0.61-1.74; P =.91; n=952), or COPD-specific mortality in 1 trial (OR, 1.25; 95% CI, 0.38-4.13; n=877). The researchers noted, however, that the wide confidence intervals suggest a lack of certainty about the precision of the results. .
Limitations of this study included a high rate of reporting bias and unavailable cohort data from the studies that could potentially change the outcome of this review. In addition, the researchers could not perform all planned subgroup and sensitivity analyses because of the small number of included studies.
Ultimately, based on their review, the researchers could not definitively state that treatment with statins result in a difference in morbidity and mortality in patients with COPD. Future long-term randomized controlled trials should include participants who are more representative of the real-world cohort of patients with COPD, many of whom have multiple comorbidities.
Walsh A, Perrem L, Khashan AS, Henry MT, Ni Chroinin M. Statins versus placebo for people with chronic obstructive pulmonary disease [published online July 31, 2019]. Cochrane Database Syst Rev. doi:10.1002/14651858.CD011959.pub2