Statin Therapy in Active Crohnʼs Disease

Abstract

Purpose: HMG CoA reductase inhibitors (statins) have immunomodulatory and anti-inflammatory effects in addition to their lipid-lowering properties. Recent animal and clinical data suggest that statins may decrease intestinal inflammation in inflammatory bowel disease. Methods: Eighteen patients with active Crohn's disease (Harvey-Bradshaw Index >5) were given rosuvastatin 20mg (n = 7) or pravastatin 80mg (n = 11) daily for 6 weeks. Patients were on a stable medical regimen for at least 4 weeks prior to initiating statin therapy. Clinical disease activity was measured by the Harvey-Bradshaw Index prior to and at the end of therapy. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also measured pre-and post-therapy. Results: Five patients in the rosuvastatin group and seven patients in the pravastatin group completed six weeks of therapy. There were no significant differences in disease activity after 6 weeks of therapy with rosuvastatin or pravastatin as defined by HBI (rosuvastatin 10 v. 11.2, p = 0.73; pravastatin 11 v. 7.4, p = 0.13). There were no significant differences in CRP (rosuvastatin 0.8 v. 1.3 mg/dL, p = 0.84; pravastatin 0.8 v. 1.2 mg/dL, p = 0.16) or ESR (rosuvastatin 17 v. 21 mm/hr, p = 0.94; pravastatin 12 v. 17 mm/hr, p = 0.37). Of the six patients that did not complete statin therapy, four patients discontinued treatment because of worsening Crohn's symptoms, one patient developed myalgias after initiating rosuvastatin, and one patient was lost to follow up. Two patients had asymptomatic elevations in creatine kinase at week 6 of statin therapy. Conclusion: In patients with active Crohn's disease, rosuvastatin and pravastatin were not associated with significant changes in disease activity after six weeks of therapy. Neither rosuvastatin nor pravastatin were associated with reductions in ESR or CRP. Statin therapy was generally safe and well tolerated in this patient population. Further evaluation of pravastatin in Crohn's disease is ongoing.