In elderly patients who are admitted to the hospital with community-acquired pneumonia with sepsis (CAP+S) and do not require critical care unit support, the use of high-dose simvastatin has been linked to improvements in neutrophil function and clinical outcomes.
A randomized, double-blind, placebo-controlled study was conducted among patients aged ≥55 years with CAP+S who were admitted to a secondary care hospital in the United Kingdom. Results of the study were published in the American Journal of Respiratory and Critical Care Medicine.
Investigators sought to determine whether treatment with high-dose simvastatin was associated with improvements in neutrophil function and would be safe and well tolerated in older hospitalized adults with CAP+S who were not admitted to the critical care unit. They compared treatment with simvastatin 80 mg vs placebo for 7 days among the study population. The primary end point was change in neutrophil extracellular trap formation at day 4 compared with day 0. Secondary end points at day 4 included neutrophil chemotaxis, safety and tolerability, mortality, readmission, Sequential Organ Failure Assessment score, and markers of tissue degradation/inflammation. There were 32 patients in the simvastatin treatment group and 30 patients in the placebo group.
In patients with CAP+S, 4 days of simvastatin adjuvant treatment was associated with improved neutrophil extracellular trap formation and chemotaxis, a decrease in systemic neutrophil elastase burden, and improvements in Sequential Organ Failure Assessment scores compared with placebo. Moreover, a post hoc analysis showed that compared with placebo, simvastatin was associated with improved hospitalization-free survival.
Simvastatin was safe and well tolerated in this elderly, multimorbid patient population, in whom the concomitant prescription of macrolide antibiotics was common.
The investigators concluded that the data from this study imply that the patient population, dose, and timing of the statin intervention are all crucial. A larger, multicenter clinical trial is warranted to evaluate the potential benefit of this treatment in this vulnerable population.
Sapey E, Patel JM, Greenwood H, et al. Simvastatin improves neutrophil function and clinical outcomes in pneumonia: a pilot randomised controlled trial [published online June 17, 2019]. Am J Respir Crit Care Med. doi:10.1164/rccm.201812-2328OC