Statins are associated with reduced use of steroids in inflammatory bowel disease: A retrospective cohort study
Statins are associated with reduced use of steroids in inflammatory bowel disease: A retrospective cohort study
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DOI：
10.1002/ibd.21822
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发表时间：
2012-06-01
影响因子：
4.9
通讯作者：
Kappelman, Michael D.
中科院分区：
文献类型：
--
作者：
Crockett, Seth D.;Hansen, Richard A.;Kappelman, Michael D.
背景：他汀类药物具有抗炎作用。我们试图确定炎症性肠病(IBD)患者中他汀类药物的使用是否与类固醇使用率或其他疾病活动标志物的减少有关。方法：我们使用管理数据进行了一项回溯性队列研究。使用他汀类药物的IBD患者与未接触他汀类药物的IBD患者进行比较。主要结果是口服类固醇处方；次要结果包括启动抗肿瘤坏死因子(TNF)、住院或腹部手术。使用COX比例风险模型估计调整了潜在混杂因素的危险比(HR)。结果：研究队列包括1986名服用他汀类药物的受试者和9871名未服用他汀类药物的受试者。他汀类药物的使用与类固醇启动率降低18%相关(HR 0.82，95%可信区间[CI]0.71，0.94)。单用阿托伐他汀有统计学意义(HR为0.76，95%CI为0.60，0.96)。他汀类药物在溃疡性结肠炎患者中与激素减少率相关(HR 0.75，95%CI 0.62，0.91)，而在克罗恩病患者中无相关性(HR 0.91，95%CI 0.74，1.12)。使用他汀类药物与使用抗肿瘤坏死因子药物(HR 0.72，95%CI 0.46，1.11)、腹部手术(HR 0.80，95%CI 0.63，1.02)和住院(HR 0.88，95%CI 0.74，1.05)的风险降低相关，但这些结果没有统计学意义。结论：在这项大型的回顾性队列研究中，IBD患者使用他汀类药物与减少口服类固醇的使用有关，尤其是对溃疡性结肠炎患者。需要进行前瞻性的临床试验，以确定他汀类药物辅助治疗IBD是否可以省去免疫抑制治疗或缓解红斑。(2012年炎症性肠病；)
Background: Statin medications have antiinflammatory effects. We sought to determine whether statin use in persons with inflammatory bowel disease (IBD) was associated with reduced rates of steroid use or other markers of disease activity. Methods: We performed a retrospective cohort study using administrative data. Statin users with IBD were compared to statin-unexposed IBD subjects. The primary outcome was an oral steroid prescription; secondary outcomes included anti-tumor necrosis factor (TNF) initiation, hospitalization, or abdominal surgery. Cox proportional hazard models were used to estimate hazard ratios (HRs) adjusted for potential confounders. Results: The study cohort included 1986 statin-exposed and 9871 unexposed subjects. Statin use was associated with an 18% reduction in the rate of steroid initiation (HR 0.82, 95% confidence interval [CI] 0.71, 0.94). A statistically significant result was seen with atorvastatin only (HR 0.76, 95% CI 0.60, 0.96). Statins were associated with a reduced rate of steroids in ulcerative colitis (HR 0.75, 95% CI 0.62, 0.91), but not in Crohn's disease (HR 0.91, 95% CI 0.74, 1.12). Statin use was associated with reduced hazard of anti-TNF use (HR 0.72, 95% CI 0.46, 1.11), abdominal surgery (HR 0.80, 95% CI 0.63, 1.02), and hospitalization (HR 0.88, 95% CI 0.74, 1.05), but these results did not reach statistical significance. Conclusions: In this large retrospective cohort study, statin use among persons with IBD was associated with reduced use of oral steroids, particularly for ulcerative colitis. Prospective clinical trials are needed to confirm whether adjuvant treatment of IBD with statin drugs may spare immunosuppressant therapy or ameliorate flares. (Inflamm Bowel Dis 2012;)