ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 895

Associations of Statin Usage with Disease Activity in Ankylosing Spondylitis

Jonathan Dau1, Lianne S. Gensler2, MinJae Lee3, Michael Ward4, Matthew Brown5, Laura A. Diekman6, Mohammad H. Rahbar7, Mariko Ishimori8, Michael Weisman9 and John D. Reveille10, 1McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, 2University of California San Francisco, San Francisco, CA, 3Biostatistics/Epidemiology/Research Design (BERD) Core | Center for Clinical and Translational Sciences, University of Texas-McGovern Medical School, Houston, TX, 4National Institutes of Health, Bethesda, MD, USA, Bethesda, MD, 5Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Brisbane, Australia, Brisbane, Australia, 6Rheumatology, McGovern Medical School at the University of Texas Health Science Center at Houston, USA, Houston, TX, 7Biostatistics/Epidemiology/Research Design (BERD) Core | Center for Clinical and Translational Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, USA, Houston, TX, 8Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, 9Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, 10McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: , ,

Session Information

Date: Sunday, October 21, 2018

Title: 3S088 ACR Abstract: Spondyloarthritis Incl PsA–Clinical I: Axial SpA Epidemiology (892–897)

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose:

Recent studies have shown possible anti-inflammatory effects and a survival benefit with statin usage in ankylosing spondylitis (AS). The purpose of this study was to assess whether statin usage is associated with lower disease activity in a longitudinal cohort of patients with AS.

Methods:

AS patients meeting modified New York Criteria with at least one year of clinical follow-up with statin usage were included in the analysis. Patients on statins were classified into high, moderate, and low intensity statins based on 2013 American Heart Association/American College of Cardiology Treatment of Cholesterol Guidelines [1].  We used a longitudinal negative binomial regression model to evaluate the effect of statin usage on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) using generalized estimating equations controlling for age, sex, ethnicity, education, smoking status, cardiovascular comorbidities, CRP, exercise, antihypertensive, nonsteroidal anti-inflammatory drugs (NSAID) and TNFi usage. We further tested interactions to see whether NSAID usage modified the longitudinal association between BASDAI scores and statin usage.

 

Results:

814 AS patients, with at least one year of follow-up, were studied. 86 of these patients were on a statin at baseline. 10 patients, 65 patients, and 11 patients were on a low, moderate, and high intensity statin respectively. Follow-up median was 4.8 years, IQR of (2.3,7.1). Statin usage alone was not significantly associated with BASDAI when it was tested in additive models (p=0.4). NSAID usage alone was significantly associated with higher BASDAI score (p<0.01).  In the interactive model, when the interaction effect between statin and NSAID usage in relation to BASDAI was assessed, of patients with an NSAID index ≥ 50%, BASDAI score was 32% lower for low intensity statin compared to no statin use (p<0.001) and 18% lower for high intensity statin compared to no statin use (p=0.004) (Table 1). ESR was collinear with CRP. When interactions of statin and TNFi usage were tested (data not shown), of the patients taking TNFi, statins were not significantly associated with lower BASDAI score. Of the patients not taking TNFi, statins were significantly associated with lower BASDAI scores for high intensity statins compared to no statin use (p<0.01).

 

Table 1:  Effect of Statin Usage on BASDAI based on Multivariable Longitudinal Model

Adjusted Rate Ratio (95% CI)

P-value

Effect of Statin Usage on BASDAI per NSAID index group (interaction between Statin and NSAID usage in relation to BASDAI)

0.150

when NSAID index ≥ 50%:

 

   Statin Low Intensity vs no use

0.68 (0.57, 0.81)

<0.001

   Statin Moderate Intensity vs no use

0.98 (0.89, 1.09)

0.703

   Statin High Intensity vs no use

0.82 (0.72, 0.94)

0.004

   Statin High Intensity vs Moderate Intensity

0.84 (0.73, 0.96)

0.009

when NSAID index < 50%:

 

   Statin Low Intensity vs no use

1.01 (0.88, 1.17)

0.848

   Statin Moderate Intensity vs no use

0.94 (0.83, 1.05)

0.286

   Statin High Intensity vs no use

1.01 (0.74, 1.38)

0.939

   Statin High Intensity vs Moderate Intensity

1.08 (0.80, 1.45)

0.616

when NSAID not used:

 

   Statin Low Intensity vs no use

1.11 (0.92, 1.35)

0.275

   Statin Moderate Intensity vs no use

1.00 (0.92, 1.08)

0.906

   Statin High Intensity vs no use

0.94 (0.82, 1.08)

0.389

   Statin High Intensity vs Moderate Intensity

0.94 (0.82, 1.09)

0.443

Education Level (college or higher) vs. other

0.78 (0.70, 0.87)

<0.001

White vs. other

0.93 (0.85, 1.03)

0.176

Male vs. female

0.87 (0.80, 0.94)

0.001

AGE ≥ 40 years vs. < 40 years

1.12 (1.04, 1.22)

0.005

Ever Smoker vs. Nonsmoker

1.15 (1.06, 1.24)

0.001

Abnormal CRP vs. normal

1.16 (1.12, 1.21)

<0.001

Cardiovascular Diseases* (hypertension excluded) vs. other comorbidities

1.10 (0.96, 1.27)

0.171

Diabetes vs. other

1.23 (1.05, 1.44)

0.012

Exercise ≥ 120 mins vs. < 120 mins

0.92 (0.89, 0.95)

<0.001

TNFi use

0.88 (0.83, 0.93)

<0.001

Antihypertensive Medication use 

1.07 (1.01, 1.14)

0.031

*cardiac bypass surgery, angioplasty (percutaneous intervention), coronary artery disease, myocardial infarction, angina, valvular heart disease, or heart valve replacement.

Conclusion:

Statins when taken with NSAIDs at anti-inflammatory doses were associated with a significant reduction in AS disease activity. TNFi may mask the anti-inflammatory effect of statins. Future studies will require more patients to confirm the effect.

[1] Stone NJ, et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Circulation. 129, S1-S45 (2013).

 

Disclosure: J. Dau, None; L. S. Gensler, UCB Pharma, 2; M. Lee, None; M. Ward, None; M. Brown, None; L. A. Diekman, None; M. H. Rahbar, None; M. Ishimori, None; M. Weisman, GSK, Lilly, Novartis, Baylx, Celltrion. All are consulting fees, 5, 6; J. D. Reveille, Janssen, 5,Eli Lilly and Co., 2, 5,UCB, Inc., 5,Novartis, 5.

To cite this abstract in AMA style:

Dau J, Gensler LS, Lee M, Ward M, Brown M, Diekman LA, Rahbar MH, Ishimori M, Weisman M, Reveille JD. Associations of Statin Usage with Disease Activity in Ankylosing Spondylitis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/associations-of-statin-usage-with-disease-activity-in-ankylosing-spondylitis/. Accessed .

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