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Statins may play a role in the treatment of inflammatory rheumatic diseases

Results from a preliminary study indicate patients with inflammatory rheumatic diseases might benefit from treatment with statin agents, reports a study from Mexico.

Although statins are widely used to treat ischaemic coronary disease, as well as to control hypercholesterolaemia, their use for inflammatory diseases is less evident, despite biochemical data that show their inhibitory effects on many processes involved in inflammatory diseases.

To evaluate the therapeutic potential of statins to treat different inflammatory rheumatic diseases that are refractory to conventional therapy, Carlos Abud-Mendoza, MD, and colleagues from Hospital Central, San Luis Potosi, Mexico, conducted a preliminary, short-term, open clinical trial to examine the effect of simvastatin 80 mg once daily or atorvastatin 20 mg once daily in 10 patients with inflammatory rheumatic diseases that was refractory to conventional therapy.

Of the 10 patients, 5 received simvastatin for systemic lupus erythematosus (SLE); three were refractory to high doses of prednisone and cyclophosphamide and azathioprine or methotrexate; two with systemic vasculitis that was refractory to high doses of prednisone and cytotoxic drugs or prednisone, cyclophosphamide, azathioprine, and etanercept. The other five patients received atorvastatin for rheumatoid arthritis (RA) that was refractory to methotrexate, sulfasalazine, azathioprine, and/or leflunomide and prednisone.

Preliminary results of the first study showed that the administration of simvastatin for 8 days was associated with a rapid and significant reduction in proteinuria levels in the three patients with SLE, as well as in the 2 patients with systemic vasculitis. In the five patients with RA, atorvastatin for 8 days was associated with a reduction in C-reactive protein levels and clinical improvement.

There was a significant reduction in spontaneous apoptosis of peripheral blood lymphocytes and expression of CD69 and human leukocyte antigen (HLA-DR) in the SLE patients treated with simvastatin. To compare the effect of short-term simvastatin versus chloroquine, the authors conducted a separate study of 15 RA patients who failed to achieve a satisfactory response after treatment with methotrexate and prednisone.

Ten patients received short-term simvastatin 40 mg/day and five received chloroquine 250 mg/day.

Preliminary results of this study showed an improved clinical response in 90% of the patients treated with simvastatin after 8 weeks, but no similar response was seen in the any of the patients treated with chloroquine.

Based on these results, the authors conclude that statins may have an important therapeutic potential for different inflammatory diseases, and that controlled trials are necessary to further test their benefit in the treatment of these diseases.
Lupus 2003;12:8:607-611. "Therapy with statins in patients with refractory rheumatic diseases: a preliminary study"

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