Simvastatin has shown benefit as an adjunct therapy in COPD, significantly extending the time to first exacerbation as well as the overall rate of exacerbations, finds new research which contradicts previous trials.
The double-blind randomised controlled trial conducted in Austria found that simvastatin at a daily dose of 40mg cut yearly COPD exacerbations by 23% compared to placebo in 209 COPD patients optimised on preventive inhaler therapy.
In patients taking simvastatin the median time to first COPD exacerbation was 341 days compared to 140 days for those in the control group, while the hazard ratio for the risk of first exacerbation was 0.51 in the simvastatin arm, equating to a significant median delay of over six months versus placebo.
The researchers found no difference in quality of life, lung function, 6-min walk test and high-sensitivity C-reactive protein between the groups.
The findings from the trial published in the European Respiratory Journal contradict the STATCOPE RCT published in 2014 that found no benefit from daily 40mg simvastatin in reducing COPD exacerbations over three years.
In an accompanying editorial, Dr Robert Young and Raewyn Scott, from the Faculty of Medical and Health Sciences, Auckland University, suggest that while the studies were comparable on a number of parameters, there were also “inherent differences” that could explain their conflicting results.
Firstly, patients included in the placebo arm of the current trial were at greater risk of exacerbation than those recruited in STATCOPE.
Furthermore, the inclusion criteria in the current trial were broader [than STATCOPE] and included patients with cardiovascular risks.
“These patient groups often have higher rates of elevated systemic inflammation, more exacerbations and poorer outcomes which might be ameliorated by statin therapy,” the editorialists noted.
Overall, the trial “provides positive evidence of a beneficial effect of simvastatin in a subgroup of patients with COPD that addresses one of the main aims of treatment: to reduce exacerbations,” they concluded.
They said the benefits of statins were thought to derive from their anti-inflammatory effects on mediators of systemic inflammation such as interleukin (IL)-6, which have been independently linked to increasing risk of COPD exacerbations in prospective studies.
However, based on current evidence “the decision to use statins in patients with COPD should be left to individual clinicians,” they added.