Asthma patients who took statins were 33% less likely to have an asthma-related hospitalization or emergency room visit during the next year, according to one analysis of a claims database reported at the American Academy of Allergy, Asthma, and Immunology meeting.
But those findings were tempered by an independent review of another claims database, also presented here, which found no particular benefit for statins in patients with severe asthma at baseline in terms of these and other markers of disease activity.
As a result, uncertainty over whether the documented anti-inflammatory effects of statins can affect the course of asthma is likely to remain for the near future.
- Explain to interested patients that statin drugs are prescribed to reduce cholesterol, but a number of studies have indicated that they have anti-inflammatory effects as well.
- Explain that asthma is an inflammatory condition, and some studies, though by no means all, have suggested that statins might reduce disease severity in asthma.
- Note that the two studies in this report both retrospectively analyzed large databases and therefore have important limitations.
- Note, too, that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
The first study, reported by Eric Stanek, Pharm.D., of the pharmacy benefits manager Medco Health Solutions, looked at ER visits and hospitalizations for asthma among patients in the firm's 12-million member database.
The Medco analysis focused on some 6,600 patients identified as poorly controlled asthmatics on the basis of having received a prescription for inhaled corticosteroids and at least one hospitalization or ER visit during the preceding year. Roughly one-third were also prescribed a statin drug.
Dr. Stanek said the raw data indicated that, among those taking statins, hospitalizations in the following year were 18% lower and ER visits 44% lower.
After adjusting for a variety of other factors that differed between the statin and no-statin patients -- rates of major cardiovascular events, diabetes, age, sex, and very poor asthma control -- the odds rate for hospitalization or ER visit remained significant at 0.67 (95% CI 0.58 to 0.76).
Looked at separately, the effect was nearly identical for hospitalizations and ER visits, with odds ratios of 0.73 and 0.72, respectively (P<0.001>
But a different analysis -- by researchers from Kaiser Permanente in San Diego using that organization's massive database -- found no suggestion that statins do much for patients with severe asthma.
Their study examined one-year outcomes among about 7,800 asthmatics after they started taking statins for high cholesterol.
According to Kaiser researcher Sandra Christiansen, M.D., the statin-treated patients were initially much sicker -- in terms of asthma severity as well as comorbid disease -- than those not given statins.
Compared with no-statin controls, the statin group was more likely to be taking corticosteroids and to have other diseases such as diabetes; the proportion of statin users with diabetes was greater in this study than in the Medco study.
ER visits and hospitalizations were also significantly more common in the statin-prescribed patients at baseline.
"Statin therapy did not narrow these discrepancies," Dr. Christiansen reported, with similar or even higher adjusted rates of such asthma severity markers as hospitalizations, ER visits, and use of rescue albuterol and oral corticosteroids.
Dr. Christiansen said it appears that asthma patients selected for statin prescription "appear to have inherently more severe disease," which statin treatment can't overcome.
She suggested that perhaps the Medco study had failed to control for as many variables as her own, as the Kaiser database contains more clinical detail on its members.
Dr. Christiansen acknowledged that, despite her group's findings, it remains possible that statins can help at least a subset of asthma patients.
"We just didn't see it," she shrugged.
For his part, Dr. Stanek said the two studies were not actually in conflict. He said the statin-treated asthmatic patients in the Kaiser study appeared much sicker than those in the Medco database.
He agreed that, in that population, statins may not be beneficial, but could still be helpful in patients with less severe initial disease.
He emphasized that the issue needs to be addressed in prospective studies and that it would be premature to prescribe statins as asthma therapy.
Nancy Ostrom, M.D., moderator of the session where Dr. Stanek presented and co-director of the Allergy and Asthma Medical Group and Research Center in San Diego, echoed those remarks.
"I don't think we have enough information to make a global change in how we practice," she said.
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