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Wednesday, November 3, 2010

Simvastatin provides little help for reducing steroid use in asthma

Statins have shown anti-inflammatory properties in animal models and human tissues, reducing airway hyperreactivity, mast cell degranulation, and inhibition of airway smooth muscle proliferation. Great hopes have been placed in the treatment of asthma by statins, but only two clinical trials have been published, though, using statins in subjects with asthma.

A double-blind, placebo-controlled, crossover study by Cowan et al. (Thorax 2010, 65:891-896) examines whether simvastatin demonstrates steroid-sparing effects across a 6 month period in 43 subjects with stable persistent asthma. All subjects started on 500μg of fluticasone and simvastatin or placebo. Fluticasone was stepped down each month for 6 months or until loss of control (LOC). Subjects were stepped up at the point of LOC until “minimum necessary” ICS dose to achieve control.

Cowan et al report that subjects at the LOC point were not significantly different between simvastatin and placebo. Nevertheless, the authors note that sputum eosinophils were lower on simvastatin than placebo. They conclude that simvastatin did not produce clinically important steroid-sparing effects, though it was associated with improvements in Asthma Control Questionnaire score and FEV1 as well as mitigating eosinophilia.

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