2023-09-01 カロリンスカ研究所(KI)
◆この観察的な研究では、約10,500人の炎症性腸疾患(IBD)患者を対象にし、半数がスタチンを使用している群と、使用していない群とを比較しました。5.6年間のフォローアップの結果、スタチンを使用した群では大腸がんの発症と死亡が少なく、保護効果は治療期間が長いほど高まりました。
◆また、スタチンは大腸がん以外の死亡リスクも低減させました。しかし、今後の研究が必要であり、一般的なガイドラインでの治療推奨にはさらなる知識が必要とされています。
<関連情報>
- https://news.ki.se/statins-linked-to-lower-risk-of-cancer-in-patients-with-ulcerative-colitis
- https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00359-0/fulltext
炎症性腸疾患患者におけるスタチン使用と大腸癌リスク Statin use and risk of colorectal cancer in patients with inflammatory bowel disease
Jiangwei Sun,Jonas Halfvarson,David Bergman,Fahim Ebrahimi,Bjorn Roelstraete,Paul Lochhead,Mingyang Song,Ola Olén,Jonas F. Ludvigsson
eClinicalMedicine Published:August 24, 2023
DOI:https://doi.org/10.1016/j.eclinm.2023.102182
Summary
Background
Statin use has been linked to a reduced risk of advanced colorectal adenomas, but its association with colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD) – a high risk population for CRC – remains inconclusive.
Methods
From a nationwide IBD cohort in Sweden, we identified 5273 statin users and 5273 non-statin users (1:1 propensity score matching) from July 2006 to December 2018. Statin use was defined as the first filled prescription for ≥30 cumulative defined daily doses and followed until December 2019. Primary outcome was incident CRC. Secondary outcomes were CRC-related mortality and all-cause mortality. Cox regression estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).
Findings
During a median follow-up of 5.6 years, 70 statin users (incidence rate (IR): 21.2 per 10,000 person-years) versus 90 non-statin users (IR: 29.2) were diagnosed with incident CRC (rate difference (RD), -8.0 (95% CIs: -15.8 to -0.2 per 10,000 person-years); aHR = 0.76 (95% CIs: 0.61 to 0.96)). The benefit for incident CRC was duration-dependent in a nested case-control design: as compared to short-term use (30 days to <1 year), the adjusted odd ratios were 0.59 (0.25 to 1.43) for 1 to <2 years of use, 0.46 (0.21 to 0.98) for 2 to <5 years of use, and 0.38 (0.16 to 0.86) for ≥5 years of use (P for tread = 0.016). Compared with non-statin users, statin users also had a decreased risk for CRC-related mortality (IR: 6.0 vs. 11.9; RD, -5.9 (-10.5 to -1.2); aHR, 0.56 (0.37 to 0.83)) and all-cause mortality (IR: 156.4 vs. 231.4; RD, -75.0 (-96.6 to -53.4); aHR, 0.63 (0.57 to 0.69)).
Interpretation
Statin use was associated with a lower risk of incident CRC, CRC-related mortality, and all-cause mortality. The benefit for incident CRC was duration-dependent, with a significantly lower risk after ≥2 years of statin use.
Funding
This research was supported by Forte (i.e., the Swedish Research Council for Health, Working Life and Welfare).
