12 April 2018, Paris, France: A large register-based study conducted in Sweden has found that statins are associated with a markedly reduced risk of all-cause mortality, liver transplantation, liver cancer, and variceal bleeding in patients with primary sclerosing cholangitis (PSC). The study, which reviewed the records of almost 3,000 patients diagnosed with PSC between 2005 and 2016, also reported a reduced risk of these outcomes in patients receiving azathioprine, but not in those receiving ursodeoxycholic acid (UDCA).
There is increasing evidence that statins are beneficial in patients with chronic liver and cholestatic diseases.1-4 As well as lowering cholesterol, statins act beneficially through different pleiotropic mechanisms on inflammation, fibrosis, endothelial function, thrombosis, and coagulation to potentially improve chronic liver disease,1 and they have been associated with beneficial effects on markers of cholestasis in patients with cholestatic liver disease.4
The award-winning study,* presented today at The International Liver Congress™ 2018 in Paris, France, was conducted to assess the impact of exposure to different drugs, including statins, UDCA, aminosalicylates, antibiotics, azathioprine, and corticosteroids, on various clinical outcomes in patients with PSC. A total of 2,914 patients were identified from different registers and included in the analysis. All patients had Crohn's disease or ulcerative colitis (or both); the total follow-up time was 11,769 patient years. Of the patients included in the analysis, 74.4% had been exposed to 5-aminosalicylic acid, 60.2% to UDCA, 33.7% to azathioprine/mercaptopurine, 91% to antibiotics, 12.1% to antimycotics, 34.2% to metronidazole, 69.3% to corticosteroids, and 13.9% to statins. Exposure was defined as the time from the first dispensing of the drug after 2005 to the end of the study period.
'Both azathioprine and statins were associated with a decreased risk of death, liver transplantation and variceal bleeding in our study', said Dr Knut Stokkeland from Visby Hospital and the Karolinska Institute in Sweden, who presented the results today. 'Statins were associated with a decreased risk of all-cause mortality by 32% and a decreased risk of death or liver transplantation by 50%'.
'This is the first study of statins in PSC - a condition for which, today, there are no other medical therapies', noted Dr Stokkeland. 'We think that statins may be promising candidates for the treatment of PSC; however, there is currently insufficient evidence to justify recommending routine use of these agents in PSC. Further evaluation, preferably in a randomized controlled setting, needs to be undertaken'.
'Primary sclerosing cholangitis is a disease that still has no ideal treatment options', said Prof. Marco Marzioni from the University Hospital of Ancona, Italy, and EASL Governing Board Member. 'Although registries are not equivalent to clinical trials and thus cannot lead to any solid therapeutic recommendations, they are of great value in understanding the general features of diseases, particularly in rarer diseases such as PSC. This study offers the possibility to study the potential effectiveness of statins in PSC, and may be helpful in informing future clinical trials to unveil novel therapeutic pathways'.
About The International Liver Congress™
This annual congress is the biggest event in the EASL calendar, attracting scientific and medical experts from around the world to learn about the latest in liver research. Attending specialists present, share, debate and conclude on the latest science and research in hepatology, working to enhance the treatment and management of liver disease in clinical practice. This year, the congress is expected to attract approximately 10,000 delegates from all corners of the globe. The International Liver Congress™ 2018 will take place from 11¬-15 April 2018 at the Paris Convention Centre, Paris, France.
About The European Association for the Study of the Liver (EASL)
Since its foundation in 1966, this not-for-profit organization has grown to over 4,000 members from all over the world, including many of the leading hepatologists in Europe and beyond. EASL is the leading liver association in Europe, having evolved into a major European Association with international influence, with an impressive track record in promoting research in liver disease, supporting wider education and promoting changes in European liver policy.
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Onsite location reference
Session title: Parallel session: Autoimmune and cholestasis 2
Cholestasis and autoimmune
Time, date and location of session: 14. April 2018, 08:00 AM - 08:15 AM, South 1
Presenter: Annika Bergquist, Sweden
Abstract: Statins are associated with reduced mortality and morbidity in primary sclerosing cholangitis (PSC) (1926)
None of the authors have anything to disclose.
5. Schierwagen R, et al. Rationale for the use of statins in liver disease. Am J Physiol Gastrointest Liver Physiol. 2017;312(5):G407-12.
6. Vargas JI, et al. Use of statins in patients with chronic liver disease and cirrhosis: current views and prospects. Curr Gastroenterol Rep. 2017;19(9):43.
7. Abraldes JG, Burak KW. STAT order: should patients with chronic liver disease be prescribed statins to prevent fibrosis progression and hepatocellular carcinoma? Hepatology. 2016;64(1):13-5.
8. Kuver R. The effects of statins on cholestasis: good, bad or indifferent? J Gastroenterol Hepatol. 2011;26(10):1467-9.