Statins for Pneumonia Not a Sure Sell

Statins to treat ventilator associated pneumonia not better than placebo in new ICU study

(RxWiki News) Medications originally created to lower cholesterol have been considered for use in treating a variety of other conditions. However, the authors of a new study say that a certain type of pneumonia may not be one such condition.

According to the study authors, the cholesterol medications called statins, which include Lipitor and Zocor, have been associated with positive outcomes in a number of infections.

In this new study, however, the researchers found that statins did not improve survival rates over a 28-day period in patients with ventilator-associated pneumonia — a type of pneumonia common in intensive care units.

"Talk to your doctor about how to prevent hospital acquired infections."

The authors of the new study, led by Laurent Papazian, MD, PhD, of Hôpital Nord in Marseille, France, reported that pneumonia in people receiving mechanical ventilation, called ventilator-associated pneumonia (VAP), is the most common intensive care unit (ICU) infection and can often lead to death.

"Ventilator-associated pneumonia (VAP) is diagnosed in approximately 8 percent to 28 percent of ICU patients receiving mechanical ventilation and remains associated with increased mortality rates and high healthcare costs," Dr. Papazian and colleagues wrote.

The researchers wanted to see if treatment with statins could lower death rates in patients with VAP during a 28-day period.

Dr. Papazian and colleagues focused on 26 ICUs in France during January 2010 to March 2013. In total, 300 patients were followed. All participants required mechanical ventilation for more than two days and were suspected of having VAP. None of the participants were already using statins when the study began.

Patients received either 60 milligrams of simvastatin (Zocor) or a placebo (an inactive, false medication). Treatment began on the day that the patient's antibiotic treatment started and lasted until either the 28th day of treatment, discharge from the ICU or death, whichever event happened first.

Only 7 percent of the simvastatin group and 11 percent of the placebo group had used statin medications in the month prior to their ICU admission.

By day 28, 21.2 percent of the simvastatin group had died, compared to 15.2 percent of the placebo group. 

In patients who had not recently received statins, day 28 mortality (death rate) was measured at 21.5 percent in the simvastatin group and 13.8 percent in the placebo group.

Dr. Papazian and colleagues planned for the study to continue until 1,002 patients were enrolled, but they ended the study after the initial 300 patients.

"[I]t would have been ethically unacceptable to continue the trial after the interim analysis, which showed higher day-28 mortality in the simvastatin group, even though the increase was not statistically significant," the study authors explained.

In this study, statins did not improve 28-day survival over a placebo in adults suspected of having VAP. "These findings do not support the use of statins with the goal of improving VAP outcomes," Dr. Papazian and colleagues concluded.

"Ventilator assisted pneumonia is a complex issue which requires a physician to balance antibiotic, respiratory and circulatory therapy while the nursing staff maintains 24 hour care to assure all parameters are being monitored appropriately.   It is clear to me, after evaluating the results of this study of 300 cases, that adding a statin to the medication regimen of an intensive care unit patient with pneumonia will not increase their chance of survival," Steve Leuck, PharmD, Owner/President of AudibleRx, told dailyRx News.

Further research is needed to confirm these findings.

This study was published online October 9 in the Journal of the American Medical Association (JAMA). Several of the authors reported receiving payment in exchange for lectures, expert testimony or travel expenses from a number of medical equipment and pharmaceutical companies, including Fresenius Kabi, Merck France and Gilead.

Review Date: 
October 7, 2013