Adjunctive Lovastatin Falls Short in Mildly Active Rheumatoid Arthritis

The use of adjunctive lovastatin failed to reduce disease activity or lower C-reactive protein (CRP) level in patients with mildly active rheumatoid arthritis (RA), according to results from a study published in Rheumatology.

Researchers conducted a double-blind, placebo-controlled, randomized study of 64 patients with mildly active RA (ClinicalTrials.gov identifier: NCT00302952). Study patients were randomly assigned to receive either lovastatin 80 mg daily (n=34) or placebo (n=30) for a total of 12 weeks. Lovastatin was administered in combination with disease-modifying antirheumatic drug therapy and/or maintenance prednisone (up to 10 mg/d), and/or biologic therapy; however, no drug changes were permitted during the study. The primary outcome measured was reduction in CRP; secondary outcomes were anti-cyclic citrullinated peptide and rheumatoid factor antibody titers, as well as disease activity.

At 12 weeks, the researchers found no significant difference in CRP reduction between the treatment arms (P =.8). In addition, disease activity remained unchanged from baseline in both arms.

After mechanistic analysis, no significant changes in anti-cyclic citrullinated peptide and rheumatoid factor antibody titers were observed in either group.

One key limitation of the study was the lack of complete patient enrollment, which could have introduced type II error.

“Although we observed no anti-inflammatory or clinical effects of lovastatin, statins may still benefit RA patients because accelerated atherosclerosis and cardiovascular events are increased in RA,” the researchers wrote.

“Identification of subpopulations of RA patients who may have an anti-inflammatory response to statins remains to be demonstrated in future studies,” they concluded.

Reference

Aranow C, Cush J, Bolster MB, et al. A double-blind, placebo-controlled, phase II, randomized study of lovastatin therapy in the treatment of mildly active rheumatoid arthritis [published online October 18, 2019]. Rheumatology. doi:10.1093/rheumatology/kez471