Statins Again!

Statins may now have yet another indication, Rick and I reveal on PodMed this week: help in halting brain atrophy in folks unfortunate enough to have progressed to secondary progressive multiple sclerosis, as reported in the Lancet.  And the number of people who do progress is quite large, since multiple sclerosis, or MS, afflicts literally millions of people worldwide.  While the exact prevalence is not known, what is known is that the condition usually develops when people are 20 to 50 years of age, with about twice as many more women than men affected.  After an initial presentation of what is called 'relapsing remitting' disease, where periods of acute inflammatory activity are followed by periods of relative stability, more than half of people with MS will eventually progress to the relentless form of the disease, with concomitant loss of function and a reduced life expectancy of 5 to 10 years.

The hallmark characteristics of MS are plaques, areas where myelin is destroyed in largely white matter areas of the brain and spinal cord, inflammation, and brain atrophy.  Enter statins, specifically simvastatin. In this study 140 subjects with secondary, progressive MS were randomized to high-dose simvastatin (80 mg) or placebo for 24 months. MRI scans of each subject's brain were obtained at baseline, 12 months and 25 months. Brain volume and number of lesions were assessed.  An additional outcome measure included clinical assessment of function and impact of the disease. Cholesterol was also measured.

Impressively, the study reported a 43% reduction in the annualized rate of brain atrophy among those folks who took simvastatin compared to placebo. Predictably, their cholesterol was also reduced.  The drug was well-tolerated and side effects were minimal.  While the brain atrophy score was positively impacted, no other measures demonstrated a benefit, including the appearance of lesions, or clinical or immunological assessments.  The authors conclude that the results are persuasive enough to more forward to a phase 3 trial, and we agree.  We also agree that based on the results of this study, it's likely that many physicians who treat folks with secondary progressive MS will begin prescribing simvastatin off-label, invoking what I like to call the 'chicken soup hypothesis,' that is, it can't hurt.  Said with a heavy New York inflection, naturally.

Clearly, another direction that occurs to us is the utilization of statins earlier in the course of the disease as a potential prophylactic measure.  Rick and I part company here as he cites the fact that effective immunomodulatory agents exist for the initial stages of MS, but I am intrigued by the evident anti-inflammatory effect of statins as discerned in a number of other conditions and situations and wonder if they might not be more helpful if used in this capacity. No doubt future studies will address this question.

Other topics this week include neuraminidase inhibitors and flu mortality in Lancet Respiratory Medicine, genetic profiles and impact of fatty food consumption in the BMJ, and H.influenzae risk in pregnancy in JAMA.  Until next week, y'all live well.

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Stephen in Birmingham April 24, 2014 at 5:38 pm

I'll admit that I am still a little shaky when it comes to the usage of statins, especially after reading that the new cholesterol guidelines could mean a lot more people will be prescribed this drug. Granted I was surprised and impressed that statins could be used effectively to combat brain atrophy in MS patients. Oh and speaking of being well tolerated, I read that Johns Hopkins was recently testing a lower intensity statin that could be combined with bile acid sequestrates. Anything new happening with that research?

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