Cholesterol-lowering statins may reduce colorectal cancer incidence and mortality in patients with ulcerative colitis, according to a recent study published by Sun et al in eClinicalMedicine. The findings also suggested that statin use may be associated with a lower risk of all-cause mortality in patients with ulcerative colitis or Crohn’s disease.
Background
Previous studies have shown that the risk of colorectal cancer in patients with inflammatory bowel disease (IBD) may be 50% higher than in the general population—potentially as a result of chronic gut inflammation. Researchers have long sought treatments to reduce the risk of inflammation-related cancer.
“Even though more studies are needed to confirm our results, our study suggests that statins can prevent colorectal cancer in patients with IBD, which is a high-risk group for this kind of cancer,” explained lead study author Jiangwei Sun, PhD, a researcher in the Department of Medical Epidemiology and Biostatistics at the Karolinska Institutet.
Study Methods and Results
In the new observational study, investigators analyzed the outcomes of 10,500 patients with IBD—50% of whom received statins and 50% of whom did not receive statins.
The investigators noted that the new study was based on the ESPRESSO cohort.
“In that we can combine tissue data from patients with colorectal cancer with data from Swedish health registries, we’re uniquely placed to study the long-term effects of drugs for IBD,” underscored senior study author Jonas F. Ludvigsson, MD, PhD, Professor in the Department of Medical Epidemiology and Biostatistics at the Karolinska Institutet and a pediatrician at Örebro University Hospital. “Our hope is that these studies will improve the care of IBD patients.”
After an average follow-up of 5.6 years, the investigators found that 70 patients in the statin group and 90 patients in the non-statin group had been diagnosed with colorectal cancer. Further, compared with those who did not receive statins, the patients who did receive statins had a lower incidence of colorectal cancer–related mortality (20 vs 37) and all-cause mortality (529 vs 719).
The investigators emphasized that the protective effects of statins were directly proportional to the length of time the patients had been on the drugs and could be demonstrated after 2 years of treatment.
The investigators estimated that 200 patients with IBD needed to be treated with statins to avoid one case of colorectal cancer or cancer-related mortality within 10 years of treatment onset. However, the protective effects were only statistically valid for patients with ulcerative colitis.
“We think this is because the study contained fewer patients with Crohn’s disease,” Dr. Sun hypothesized. “More and larger studies compiling data from patient populations in many countries will probably be needed to achieve statistical significance for Crohn’s disease,” he added.
To avoid one case of all-cause mortality during the same 10-year period, 20 patients with IBD would need to be treated with statins because the drugs may also offer protective effects against more common conditions such as cardiovascular disease. Statins were also linked to fewer deaths in both patients with ulcerative colitis and Crohn's disease.
Conclusions
The investigators highlighted that the new findings provide convincing evidence that statins could be an effective prophylactic for colorectal cancer among patients with IBD. Nonetheless, more knowledge must be gathered before the treatment can be recommended for clinical use.
“More studies are needed to ascertain if there is a causal relationship, at what point of the pathological process statins should be administered, what a reasonable dose would be, and how long treatment needs to last if it’s to be of benefit,” concluded Dr. Sun.
Disclosure: The research in this study was funded by the Swedish Research Council for Health, Working Life and Welfare. For full disclosures of the study authors, visit thelancet.com.
