Simvastatin in the treatment of asthma: lack of steroid-sparing effect
Simvastatin in the treatment of asthma: lack of steroid-sparing effect
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DOI：
10.1136/thx.2010.138990
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发表时间：
2010-10-01
期刊：
影响因子：
10
通讯作者：
Taylor, D. Robin
中科院分区：
文献类型：
--
作者：
Cowan, Douglas C.;Cowan, Jan O.;Taylor, D. Robin
背景他汀类药物具有抗炎作用，理论上对哮喘有潜在益处。小型试验未能显示出显着的益处，但尚未进行评估他汀类药物治疗的类固醇节省效果的系统研究。 方法 对 51 名患有哮喘和痰嗜酸性粒细胞的患者进行了一项随机、安慰剂对照、交叉试验，夜间服用 40 mg 辛伐他汀，同时逐步减少丙酸氟替卡松剂量直至失去控制，然后增加直至恢复控制（所需的“最小”剂量） （不含类固醇）>= 2%。结果 43 名患者完成了研究。辛伐他汀和安慰剂之间的“最低”吸入皮质类固醇 (ICS) 剂量要求没有显着差异：（中位值 (IQR) 每天 50 毫克 (0-250) 对比每天 100 微克 (0-250)，p=0.931）。 “最小”剂量分布相似（p=0.269）。发生失控的氟替卡松剂量在辛伐他汀和安慰剂之间没有显着差异（p=0.404）。在两个治疗组均失去控制的患者中，失去控制时的氟替卡松剂量与辛伐他汀和安慰剂相似（两者的中位值 (IQR) 均为每天 50 mg (0-100)，p=0.620）。在达到 0 mg/天的患者 (n=18) 中，阿斯玛控制问卷 (ACQ) 较低 (p=0.037)，1 秒用力呼气量 (FEV1) 较高 (p
Background Statins have anti-inflammatory actions which in theory are potentially beneficial in asthma. Small trials have failed to show a significant benefit, but a systematic study to evaluate the steroid-sparing effect of statin treatment has not been carried out.Methods A randomised, placebo-controlled, crossover trial was conducted of simvastatin 40 mg at night with simultaneous stepwise reduction of fluticasone propionate dose until loss of control occurred, followed by an increase until regain of control ('minimum' dose required) in 51 patients with asthma and sputum eosinophils (steroid-free) >= 2%.Results 43 patients completed the study. There was no significant difference in 'minimum' inhaled corticosteroid (ICS) dose requirement between simvastatin and placebo: (median (IQR) 50 mg daily (0-250) vs 100 mu g daily (0-250), p=0.931). 'Minimum' dose distribution was similar (p=0.269). The fluticasone dose at which loss of control occurred did not differ significantly between simvastatin and placebo (p=0.404). In patients with loss of control in both treatment arms, fluticasone dose at loss of control was similar with simvastatin and placebo (median (IQR) 50 mg daily (0-100) for both, p=0.620). In those patients who reached 0 mg/day (n=18), Astma Control Questionnaire (ACQ) was lower (p=0.037), forced expiratory volume in 1 s (FEV1) higher (p