Impact of statins on lung function decline in idiopathic pulmonary fibrosis (IPF)
23 February 2017 (online)
Previously published data suggest that statin use might attenuate pulmonary function decline in IPF while other reports discuss the potential of statins to increase susceptibility to interstitial lung diseases.
To assess the clinical relevance of statins in IPF.
Patients randomly assigned to placebo in 3 large, controlled trials of pirfenidone in IPF (CAPACITY 004 & 006, ASCEND) were categorized by statin use. Groups were analyzed for mortality, hospitalization, decrease in FVC and 6MWD and progression-free survival (FVC decrease ≥10%, 6MWD decrease ≥50 m, or death) in a post-hoc analysis.
Of a total of 624 patients, 276 (44%) were statin users and 348 (56%) non-users. Groups were similar with regards to age, sex and physiologic measures at baseline but differed in relevant comorbidities, mainly cardiovascular disease and its risk factors. In univariate analyses, FVC decrease ≥10% or death differed significantly between groups favoring statin use (HR = 0.7; p = 0.012), while for progression-free survival there was a trend in favor of statins (HR = 0.8; p = 0.074). A significantly greater proportion of patients in the non-statin users (54.9%) had a relative decline in FVC % predicted of ≥5% compared to the statin users (48.6%, p = 0.038), while there was no difference in mean FVC decline (p = 0.276). For statins, multivariate analyses showed a positive impact on all-cause hospitalization (HR = 0.6; p = 0.027) and a trend for improved IPF-related mortality (HR = 0.5; p = 0.076).
This retrospective post-hoc analysis suggests a potential benefit of statins on relevant clinical outcomes in IPF. However, these findings need validation in prospective clinical trials.