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Statins are associated with reduced use of steroids in inflammatory bowel disease: A retrospective cohort study*

Crockett, Seth D. MD, MPH1; Hansen, Richard A. PhD2; Stürmer, Til MD, MPH3; Schectman, Robin MSPH4; Darter, Jane BA4; Sandler, Robert S. MD, MPH1; Kappelman, Michael D. MD, MPH5

doi: 10.1002/ibd.21822
Original Article: Original Clinical Articles

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;)

1Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina

2Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina

3Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina

4Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina

5Division of Pediatric Gastroenterology, University of North Carolina School of Medicine, Chapel Hill, North Carolina

Division of Gastroenterology and Hepatology, University of North Carolina, CB 7080, Chapel Hill, NC 27599

Email: sethc@med.unc.edu

Received 11 April 2011; Accepted 10 June 2011

Published online 8 August 2011.

Supported by a grant from the North Carolina TraCS Institute (Award number UL1RR025747 from the National Center for Research Resources), as well as by funding from the National Institutes of Health: T32 DK 07634 (to S.D.C.), and KL2 RR025746 (to M.D.K.).

© Crohn's & Colitis Foundation of America, Inc.
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