Statin Use Is Associated With Improved Outcomes of Patients With Primary Sclerosing Cholangitis

Clin Gastroenterol Hepatol. 2019 Aug;17(9):1860-1866.e1. doi: 10.1016/j.cgh.2018.11.002. Epub 2018 Nov 15.

Abstract

Background & aims: There is increasing evidence that statins can benefit patients with chronic liver diseases, but their effects have not been studied in patients with primary sclerosing cholangitis (PSC). We performed a nationwide study in Sweden to determine the effects of exposure to drugs, including statins, in patients with PSC.

Methods: We studied a population-based cohort of patients in Sweden with PSC and concomitant ulcerative colitis or Crohn's disease from 2005 through 2014 (n = 2914), followed through 2016. We collected analyzed data from the patient register, the prescribed drug register, the death certificate register and the cancer register. We calculated risk or death, liver transplantation, bleeding of esophageal varices, and cancer in relation to drug exposure.

Results: The mean age of patients at the time of diagnosis with PSC was 41.4 years (inter-quartile range [IQR], 25.6-56.1 years). The total follow-up time was 11769 person-years, during which 3.4% of patients received liver transplants and 19.9% died. Proportions of patients exposed to drugs were: ursodeoxycholic acid, 60.2%; 5-aminosalicylic acid, 74.4%; azathioprine or mercaptopurins, 33.7%; and statins, 13.9%. Statin use was associated with a reduced risk of all-cause mortality (hazard ratio [HR], 0.68; 95% CI, 0.54-0.88) and death or liver transplantation (HR, 0.50; 95% CI, 0.28-0.66). Use of azathioprine was also associated with reduced mortality (HR, 0.66; 95% CI, 0.52-0.84) and risk of death or liver transplantation (HR, 0.65; 95% CI, 0.50-0.83). Exposure to ursodeoxycholic acid did not affect mortality (HR, 1.04; 95% CI, 0.87-1.25).

Conclusion: In a population-based cohort of patients in Sweden with PSC, we associated use of statins and azathioprine with decreased risks of death and death or liver transplantation. Exposure to ursodeoxycholic acid was not associated with reduced mortality.

Keywords: 5-ASA; UDCA; cholangiocarcinoma; inflammatory bowel disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Azathioprine / therapeutic use*
  • Cholagogues and Choleretics / therapeutic use
  • Cholangitis, Sclerosing / complications
  • Cholangitis, Sclerosing / drug therapy*
  • Colitis, Ulcerative / complications
  • Colitis, Ulcerative / drug therapy
  • Crohn Disease / complications
  • Crohn Disease / drug therapy
  • Esophageal and Gastric Varices / epidemiology
  • Female
  • Gastrointestinal Hemorrhage / epidemiology
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Immunosuppressive Agents / therapeutic use*
  • Inflammatory Bowel Diseases / complications
  • Inflammatory Bowel Diseases / drug therapy*
  • Liver Transplantation / statistics & numerical data*
  • Male
  • Mesalamine / therapeutic use
  • Middle Aged
  • Mortality*
  • Proportional Hazards Models
  • Protective Factors
  • Registries
  • Sweden / epidemiology
  • Ursodeoxycholic Acid / therapeutic use

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Cholagogues and Choleretics
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Immunosuppressive Agents
  • Mesalamine
  • Ursodeoxycholic Acid
  • Azathioprine