Statin類藥物可降低血清陰性脊椎關節病變之死亡率


  【24drs.com】根據一篇人口基礎研究之結果,對於僵直性脊椎炎或乾癬性關節炎的患者,statin類藥物或許可以降低死亡率風險達32%。
  
  第一研究者、波士頓麻州綜合醫院Amar Oza醫師表示,研究結果認為,對於這類患者,醫師們應考慮比以往更早開立statin類藥物。他表示,因為有可降低死亡率這方面的好處,如果有其他原因要開始使用statin類藥物,我當然(希望有)一個比較低的閾值。
  
  研究結果發表於美國風濕病學院2016年年會。
  
  研究者從「健康改善網絡(The Health Improvement Network,THIN)」資料庫辨識患有僵直性脊椎炎與乾癬性關節炎的患者,這個資料庫共有1,110萬名於英國一般開業機構就診之患者的資料。
  
  他們使用時間分層傾向得分匹配探討2,904名開始使用statin類藥物之患者、以及2,904名沒有使用這類藥物者的所有原因死亡率。
  
  一項包括3,389名開始使用statin類藥物以及3,389未使用者的未匹配分析,則是為了證明傾向得分匹配分析之效度。在未匹配分析中,使用statin類藥物者與未使用者,在年齡、共病症、膽固醇值等方面,開始時之差異即是顯著的,分析結果是使用statin類藥物者的死亡率風險高出44%。
  
  Oza醫師解釋,這確認了我們的瞭解,也就是statin類藥物一般是開立給比較嚴重的患者,這些嚴重患者的累積死亡率高於不需要statin類藥物治療者。
  
  不過,進行傾向得分匹配以平衡干擾因素之後,在平均5.3年追蹤期間,statin類藥物使用者的死亡人數少於未使用者(271 vs 376)。
  
  Oza醫師報告指出,這表示,statin類藥物使用者的發生率低於未使用者(17.6 vs 25.1/1000人-年),使用statin類藥物的所有原因死亡率風險比為0.68 。
  
  同時考量僵直性脊椎炎與乾癬性關節炎患者時,statin類藥物的保護效果達到統計上的顯著意義,分別考量時則否。
  
  會議主持人、費城賓夕法尼亞大學Joan Von Feldt醫師表示,許多研究顯示,對於我們的風濕病患者,我們或許在心血管風險方面治療不足,而這篇研究顯示,我們可以考慮將statin類藥物做為治療選項。
  
  她表示,如果這激勵了醫師們將心血管疾病視為風濕性疾病的關節外表現,我們將可以有一個更適當的風險管理方法提供給這些患者。
  
  Von Feldt醫師解釋,雖然類風濕關節炎和全身性紅斑狼瘡已被證明是心血管死亡率的獨立風險因素,迄今,僵直性脊椎炎與乾癬性關節炎都還未被納入。
  
  Oza醫師表示,僵直性脊椎炎與乾癬性關節炎的心血管風險評估,還沒有足夠的實證指引。他解釋,迄今為止,一般人口風險評估指引納入類風濕關節炎,但是,並未發表僵直性脊椎炎與乾癬性關節炎的實際資料。他認為,這是幫助這些患者的第一步。
  
  資料來源:http://www.24drs.com/
  
  Native link:Statins Cut Mortality in Seronegative Spondyloarthropathies

Statins Cut Mortality in Seronegative Spondyloarthropathies

By Kate Johnson
Medscape Medical News

WASHINGTON, DC — For patients with ankylosing spondylitis or psoriatic arthritis, statins might lower the risk for mortality by up to 32%, according to the results from a population-based study.

The findings suggest that clinicians can consider prescribing statins earlier than they previously have in this patient population, said lead investigator Amar Oza, MD, from the Massachusetts General Hospital in Boston.

"With this amount of mortality benefit, if there are other reasons to start a statin, I certainly would have a lower threshold," he told Medscape Medical News.

The results of the study were presented here at the American College of Rheumatology 2016 Annual Meeting.

The investigators identified people with ankylosing spondylitis and psoriatic arthritis from The Health Improvement Network (THIN) database, which contains data on 11.1 million patients seen in general practice in the United Kingdom.

They used time-stratified propensity score matching to look at all-cause mortality in 2904 patients who initiated statin use and 2904 who did not.

An unmatched analysis, involving 3389 patients who initiated statin use and 3389 who did not, was conducted to demonstrate the validity of propensity score matching.

In the unmatched analysis, baseline differences in age, comorbidities, and cholesterol levels between statin initiators and noninitiators were significant. This translated to a mortality risk that was 44% higher in initiators.

"This confirms our understanding that statins are generally prescribed in sicker patients, who will go on to have a higher cumulative mortality than patients not requiring statin treatment," Dr Oza explained.

However, after propensity score matching, which was aimed at balancing confounders, there were fewer deaths in the statin initiators than in noninitiators during the mean follow-up of 5.3 years (271 vs 376).

This translated to lower incidence rates for statin initiators than for noninitiators (17.6 vs 25.1 per 1000 person-years), and a hazard ratio of 0.68 for all-cause mortality with statin use, Dr Oza reported.

The protective effect of statins only reached statistical significance when patients with ankylosing spondylitis and psoriatic arthritis were combined, not when they were considered separately.

"Numerous studies have shown that we probably undertreat cardiovascular risk in our rheumatic disease patients. This study demonstrates that we can consider statins as a treatment option," said session moderator Joan VonFeldt, MD, from the University of Pennsylvania in Philadelphia.

"If this motivates clinicians to think about cardiovascular disease as an extra-articular manifestation of rheumatic disease, we could have a more appropriate risk management for these patients," she told Medscape Medical News.

Although both rheumatoid arthritis and systemic lupus erythematosus have been shown to be independent risk factors for cardiovascular mortality, to date, neither ankylosing spondylitis nor psoriatic arthritis have been, Dr VonFeldt explained.

"There aren't too many evidence-based guidelines for evaluation of cardiovascular risk in ankylosing spondylitis and psoriatic arthritis," added Dr Oza.

So far, the guidelines have included rheumatoid arthritis in general-population risk calculators, but the actual data for doing that with ankylosing spondylitis and psoriatic arthritis have not been published, he explained.

"I think this is one of the first steps in going down that road and helping these patients," he added.

Dr Oza and Dr VonFeldt have disclosed no relevant financial relationships. Senior study author Hyon Choi, MD, from Massachusetts General Hospital, reports receiving research grants from AstraZeneca for unrelated projects, and acting as a consultant for Takeda Pharmaceuticals and Selecta Biosciences.

American College of Rheumatology (ACR) 2016 Annual Meeting: Abstract910. Presented November13, 2016.

    
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