Effect of HMG-CoA Reductase Inhibitor Drugs (Statins) on Systemic Lupus Erythematosus Disease Activity: A systematic review and meta-analysis

ABSTRACT

Introduction@#Statins have been shown to have antiinflammatory and immunomodulatory effects. In vitro studies show that these drugs inhibit inflammatory cells, decrease the expression of major histocompatibility complex (MHC), decrease adhesion molecules and inflammatory cytokines (IL6 and IL10), that are also implicated in SLE pathogenesis. In terms of immunomodulary effects, animal studies demonstrate that statins exacerbate/trigger cellular apoptosis and induce a shift in the Th1/Th2 balance leading to B-cell reactivity and production of pathogenic autoantibodies. Whether statins have clinical effects in SLE have not been widely studied. In terms of disease activity, studies show contradicting results. The researchers aim to determine the effect of statins on the disease activity of SLE based on the best available evidence@*Methods@#A systematic literature search of PubMed, Scopus, and Cochrane databases was done with no date and language restrictions. Included studies were on adult SLE patients and randomized controlled trials that used statins as intervention and reported SLE disease activity as an outcome measure. Two reviewers did quality appraisal, risk bias assessment, and data extraction.@*Results@#Three studies met the eligibility criteria and were included in this review. Quantitative synthesis was done. The pooled analysis of these studies suggests that atorvastatin has no significant effect on disease activity using random effects model with an overall effect of 0.12 (P=0.90, 95% CI -1.65, 1.88).@*Conclusion@#Atorvastatin neither increased nor decreased SLE disease activity. Therefore possibly it can be safely given to SLE patients without the risk of triggering or exacerbating a flare.