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Effect of 3-hydroxy-3-methylglutaryl-coenzyme a reductase inhibitor on disease activity in patients with rheumatoid arthritis: a meta-analysis.

Xing B, Yin YF, Zhao LD, Wang L, Zheng WJ, Chen H, Wu QJ, Tang FL, Zhang FC, Shan G, Zhang X - Medicine (Baltimore) (2015)

Bottom Line: A fixed-effects model was used when there was no significant heterogeneity; otherwise, a random-effects model was used.Statin therapy also significantly reduced tender joint counts, swollen joint counts, ESR, and CRP compared with placebo, but the reduction in HAQ score and VAS was not significant (P > 0.05).This meta-analysis suggested that statin therapy might be effective in the reduction of RA disease activity measured by DAS28, TJC, SJC, as well as ESR and CRP.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Rheumatology and Clinical Immunology (BX, YFY, LDZ, LW, WJZ, HC, QJW, FLT, FCZ, XZ), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; and Department of Epidemiology (GS), Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

ABSTRACT
HMG-CoA reductase inhibitors (also known as statins) are widely used as lipid-lowering agents in patients with rheumatoid arthritis (RA) to reduce their cardiovascular risk. However, whether they have an effect on RA disease activity is controversial. This study aimed to investigate the effect of statins on disease activity in RA patients. A systematic literature review was performed using the MEDLINE, EMBASE, Cochrane Library, ISI WEB of Knowledge, Scopus, and Clinical Trials Register databases. Only prospective randomized controlled trials or controlled clinical trials comparing the efficacy of statins with placebo on adult RA patients were included. The efficacy was measured according to the ACR criteria, EULAR criteria, DAS28, HAQ score, ESR, or CRP. The Jadad score was used for quality assessment. The inverse variance method was used to analyze continuous outcomes. A fixed-effects model was used when there was no significant heterogeneity; otherwise, a random-effects model was used. For stability of results, we performed leave-one-study-out sensitivity analysis by omitting individual studies one at a time from the meta-analysis. Publication bias was assessed using Egger test. A total 13 studies involving 737 patients were included in the meta-analysis; 11 studies were included in the meta-analysis based on DAS28, while the other 2 studies were only included in the meta-analysis based on ESR or CRP. The standardized mean difference (SMD) in DAS28 between the statin group and the placebo group was -0.55 (95% CI [-0.83, -0.26], P = 0.0002), with an I2 value of 68%. Subgroup analysis showed that patients with more active disease tended to benefit more from statin therapy (SMD -0.73, P = 0.01) than patients with moderate or low disease activity (SMD -0.38, P = 0.03). Statin therapy also significantly reduced tender joint counts, swollen joint counts, ESR, and CRP compared with placebo, but the reduction in HAQ score and VAS was not significant (P > 0.05). This meta-analysis suggested that statin therapy might be effective in the reduction of RA disease activity measured by DAS28, TJC, SJC, as well as ESR and CRP.

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Flowchart of the study selection.∗3 of them have only abstracts available.
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Figure 1: Flowchart of the study selection.∗3 of them have only abstracts available.

Mentions: Figure 1 describes the flowchart of the literature search. A total of 13 studies (737 patients) were finally included in the meta-analysis: 10 were full-text articles,10–12,16–22 and 3 were abstracts.23–25 Attempts were done to contact the investigators of these 3 studies to gain more information. The risk of bias of the included studies was assessed using the Jadad score (Table 1). All studies included were single-center studies (Table 1), and the number of patients enrolled ranged from 20 to 116. Twelve studies enrolled RA patients with active disease, with a mean baseline DAS28 ranging from 3.5 to 6.5. One study enrolled stable RA patients, with a mean baseline DAS28 of 2.7. Atorvastatin was used in 7 studies (414 patients) at a dose ranging from 10 to 80 mg qd. Simvastatin was used in 2 studies (129 patients) at a dose of 20 mg qd. Rosuvastatin was used in 3 studies (138 patients) at a dose of 10 mg qd. Lovastatin was used in only 1 study (56 patients) at a dose of 80 mg qd. The duration of therapy ranged from 4 weeks to as long as 48 weeks. As 11 of the studies used DAS28 to measure the final outcome,10–12,16–20,23–25 we performed the meta-analysis mainly based on DAS28. HAQ, EULAR criteria, ACR criteria, CRP, and ESR were used to measure outcomes in some of the studies (shown in Table 1).


Effect of 3-hydroxy-3-methylglutaryl-coenzyme a reductase inhibitor on disease activity in patients with rheumatoid arthritis: a meta-analysis.

Xing B, Yin YF, Zhao LD, Wang L, Zheng WJ, Chen H, Wu QJ, Tang FL, Zhang FC, Shan G, Zhang X - Medicine (Baltimore) (2015)

Flowchart of the study selection.∗3 of them have only abstracts available.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554148&req=5

Figure 1: Flowchart of the study selection.∗3 of them have only abstracts available.
Mentions: Figure 1 describes the flowchart of the literature search. A total of 13 studies (737 patients) were finally included in the meta-analysis: 10 were full-text articles,10–12,16–22 and 3 were abstracts.23–25 Attempts were done to contact the investigators of these 3 studies to gain more information. The risk of bias of the included studies was assessed using the Jadad score (Table 1). All studies included were single-center studies (Table 1), and the number of patients enrolled ranged from 20 to 116. Twelve studies enrolled RA patients with active disease, with a mean baseline DAS28 ranging from 3.5 to 6.5. One study enrolled stable RA patients, with a mean baseline DAS28 of 2.7. Atorvastatin was used in 7 studies (414 patients) at a dose ranging from 10 to 80 mg qd. Simvastatin was used in 2 studies (129 patients) at a dose of 20 mg qd. Rosuvastatin was used in 3 studies (138 patients) at a dose of 10 mg qd. Lovastatin was used in only 1 study (56 patients) at a dose of 80 mg qd. The duration of therapy ranged from 4 weeks to as long as 48 weeks. As 11 of the studies used DAS28 to measure the final outcome,10–12,16–20,23–25 we performed the meta-analysis mainly based on DAS28. HAQ, EULAR criteria, ACR criteria, CRP, and ESR were used to measure outcomes in some of the studies (shown in Table 1).

Bottom Line: A fixed-effects model was used when there was no significant heterogeneity; otherwise, a random-effects model was used.Statin therapy also significantly reduced tender joint counts, swollen joint counts, ESR, and CRP compared with placebo, but the reduction in HAQ score and VAS was not significant (P > 0.05).This meta-analysis suggested that statin therapy might be effective in the reduction of RA disease activity measured by DAS28, TJC, SJC, as well as ESR and CRP.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Rheumatology and Clinical Immunology (BX, YFY, LDZ, LW, WJZ, HC, QJW, FLT, FCZ, XZ), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education; and Department of Epidemiology (GS), Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

ABSTRACT
HMG-CoA reductase inhibitors (also known as statins) are widely used as lipid-lowering agents in patients with rheumatoid arthritis (RA) to reduce their cardiovascular risk. However, whether they have an effect on RA disease activity is controversial. This study aimed to investigate the effect of statins on disease activity in RA patients. A systematic literature review was performed using the MEDLINE, EMBASE, Cochrane Library, ISI WEB of Knowledge, Scopus, and Clinical Trials Register databases. Only prospective randomized controlled trials or controlled clinical trials comparing the efficacy of statins with placebo on adult RA patients were included. The efficacy was measured according to the ACR criteria, EULAR criteria, DAS28, HAQ score, ESR, or CRP. The Jadad score was used for quality assessment. The inverse variance method was used to analyze continuous outcomes. A fixed-effects model was used when there was no significant heterogeneity; otherwise, a random-effects model was used. For stability of results, we performed leave-one-study-out sensitivity analysis by omitting individual studies one at a time from the meta-analysis. Publication bias was assessed using Egger test. A total 13 studies involving 737 patients were included in the meta-analysis; 11 studies were included in the meta-analysis based on DAS28, while the other 2 studies were only included in the meta-analysis based on ESR or CRP. The standardized mean difference (SMD) in DAS28 between the statin group and the placebo group was -0.55 (95% CI [-0.83, -0.26], P = 0.0002), with an I2 value of 68%. Subgroup analysis showed that patients with more active disease tended to benefit more from statin therapy (SMD -0.73, P = 0.01) than patients with moderate or low disease activity (SMD -0.38, P = 0.03). Statin therapy also significantly reduced tender joint counts, swollen joint counts, ESR, and CRP compared with placebo, but the reduction in HAQ score and VAS was not significant (P > 0.05). This meta-analysis suggested that statin therapy might be effective in the reduction of RA disease activity measured by DAS28, TJC, SJC, as well as ESR and CRP.

Show MeSH
Related in: MedlinePlus