O7.2.4 Statins

Interest in a potential disease-modifying role for HMG CoA reductase inhibitors (statins) in COPD is based upon established survival benefit in cardiovascular disease (CVD) as effective lipid-lowering drugs in combination with anti-inflammatory and antioxidant effects. Systematic reviews and meta-analysis have suggested beneficial effects of statin treatment in COPD (Dobler 2009, Janda 2009, Horita 2014). Horita’s group performed meta-analysis for mortality outcomes in 10 cohort studies and reported a protective effect: HR 0.81 (0.75 – 0.86). Sensitivity analyses using subgroups and alternative modelling remained statistically significant, although the included studies were heterogeneous and publication bias was likely.

A prospective multicentre RCT explored the role of long-term simvastatin treatment (40mg/day) in exacerbation prevention in moderately severe COPD patients, who did not have any conventional indication for statin treatment (Criner 2014) [evidence level II]. The study was stopped prematurely, prior to attaining recruitment targets, due to futility. Whilst simvastatin treatment resulted in the expected improvements in dyslipidaemia, two consecutive interim analyses showed no beneficial effect on exacerbation rates or time to exacerbation in the study population as a whole, or in any subgroup.