Introduction

Statins have been associated with a reduced risk of incident inflammatory bowel disease (IBD). The effect of statins on disease progression in IBD is largely unknown.

Aims & Methods

We aimed to investigate the effect of statins on disease progression in UC and CD. We performed a nationwide register-based cohort study (2006-2020) including 19,788 adults (≥18 years) with incident ulcerative colitis (UC) and 12,582 with incident Crohn’s disease (CD). Of these, 1733 with UC and 962 with CD were identified as incident statin users after UC or CD diagnosis. Index date was set to the date of first dispensed statin prescription of ≥30 cumulative defined daily doses after diagnosis of UC or CD. Individuals with any statin prescription within 12 months prior to and up to 6 months after diagnosis were excluded. After 1:1 propensity score matching (direct matching by IBD subtype, sex, age at diagnosis, calendar year of diagnosis, and level of education, with propensity scores adjusted for comorbidities and co-medications), we compared statin users with non-users applying Cox proportional hazards modeling to estimate the risk of IBD-related surgery, hospitalizations, and disease flares (any of systemic corticosteroid prescription, start of immunomodulator, or start/switch to anti-tumor necrosis factor treatment). We reported incidence rates and multivariable-adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs). For outcomes with statistically significant estimates, we calculated number needed to treat (NNT).

Results

At start of follow-up, the median age for statin users with UC was 61 years (interquartile range (IQR) 52-69) and 59 years (IQR 49-67) for statin users with CD. In UC, the majority were males (54.9%), while in CD the sex distribution was even (males 49.5% vs. females 50.5%). During a median follow-up of 3.4 years after first statin exposure, we observed a reduced risk of IBD-related surgery in statin users compared with non-users with UC (aHR:0.55[95%CI:0.31-0.97]) and CD (0.54[0.33-0.88]). The NNTs to avoid one IBD-related surgical event per year of statin treatment were 345 and 161 for UC and CD, respectively. The risks of hospitalizations (0.68[0.51-0.91]) and disease flares (0.86[0.77-0.97]) in statin users were reduced for UC, but not for CD (0.78[0.56-1.09] and 1.02[0.88-1.19]). For UC, NNTs for hospitalizations and disease flares were 145 and 15 per year of statin treatment.

Table 1 Incidence rates, hazard ratios and number needed to treat of inflammatory bowel disease related surgery, hospitalizations, and disease flares in individuals with ulcerative colitis and Crohn’s disease with and without statin treatment 2006-2020

Conclusion

In this population-based study, statins were associated with a reduced risk of IBD-related surgery, hospitalizations, and disease flares in individuals with UC, but only with surgery in individuals with CD.

Disclosure

Dr Khalili has received consulting fees from Takeda and Aditum Bio and has received grant funding from Takeda and Pfizer. Dr Forss has served as a speaker and advisory board member for Janssen corporation and Tillotts Pharma. Dr Eriksson received grant support/lecture fee/advisory board from BMS, Takeda, Janssen Cilag, Pfizer, Abbvie. Dr Ludvigsson has coordinated an unrelated study on behalf of the Swedish IBD quality register (SWIBREG). This study received funding from Janssen corporation. He has also received financial support from MSD to develop a paper reviewing national healthcare registers in China, and has an ongoing collaboration with Takeda on celiac disease. Dr Olén has been PI on projects at Karolinska Institutet financed by grants from Janssen, Pfizer, AbbVie, Takeda, Ferring, and Bristol Myers Squibb. Karolinska Institutet has also received fees for lectures and participation by him on advisory boards from Janssen, Ferring, Galapagos, Bristol Myer Squibb, Takeda, and Pfizer. Dr Olén also reports grants from Pfizer, AbbVie, Galapagos, and Janssen in the context of national safety monitoring programs. Drs Söderling, Sun, Bröms and Ericsson declare no conflicts of interest.