PMID- 30448601
OWN - NLM
STAT- MEDLINE
DCOM- 20201028
LR  - 20210509
IS  - 1542-7714 (Electronic)
IS  - 1542-3565 (Linking)
VI  - 17
IP  - 9
DP  - 2019 Aug
TI  - Statin Use Is Associated With Improved Outcomes of Patients With Primary 
      Sclerosing Cholangitis.
PG  - 1860-1866.e1
LID - S1542-3565(18)31245-X [pii]
LID - 10.1016/j.cgh.2018.11.002 [doi]
AB  - BACKGROUND & AIMS: There is increasing evidence that statins can benefit patients 
      with chronic liver diseases, but their effects have not been studied in patients 
      with primary sclerosing cholangitis (PSC). We performed a nationwide study in 
      Sweden to determine the effects of exposure to drugs, including statins, in 
      patients with PSC. METHODS: We studied a population-based cohort of patients in 
      Sweden with PSC and concomitant ulcerative colitis or Crohn's disease from 2005 
      through 2014 (n = 2914), followed through 2016. We collected analyzed data from 
      the patient register, the prescribed drug register, the death certificate 
      register and the cancer register. We calculated risk or death, liver 
      transplantation, bleeding of esophageal varices, and cancer in relation to drug 
      exposure. RESULTS: The mean age of patients at the time of diagnosis with PSC was 
      41.4 years (inter-quartile range [IQR], 25.6-56.1 years). The total follow-up 
      time was 11769 person-years, during which 3.4% of patients received liver 
      transplants and 19.9% died. Proportions of patients exposed to drugs were: 
      ursodeoxycholic acid, 60.2%; 5-aminosalicylic acid, 74.4%; azathioprine or 
      mercaptopurins, 33.7%; and statins, 13.9%. Statin use was associated with a 
      reduced risk of all-cause mortality (hazard ratio [HR], 0.68; 95% CI, 0.54-0.88) 
      and death or liver transplantation (HR, 0.50; 95% CI, 0.28-0.66). Use of 
      azathioprine was also associated with reduced mortality (HR, 0.66; 95% CI, 
      0.52-0.84) and risk of death or liver transplantation (HR, 0.65; 95% CI, 
      0.50-0.83). Exposure to ursodeoxycholic acid did not affect mortality (HR, 1.04; 
      95% CI, 0.87-1.25). CONCLUSION: In a population-based cohort of patients in 
      Sweden with PSC, we associated use of statins and azathioprine with decreased 
      risks of death and death or liver transplantation. Exposure to ursodeoxycholic 
      acid was not associated with reduced mortality.
CI  - Copyright (c) 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.
FAU - Stokkeland, Knut
AU  - Stokkeland K
AD  - Department of Medicine, Visby Hospital, Visby, Sweden; Department of Medicine 
      Huddinge, Unit of Gastroenterology and Rheumatology, Karolinska Institutet, 
      Stockholm, Sweden.
FAU - Hoijer, Jonas
AU  - Hoijer J
AD  - Unit of Biostatistics, Institute of Environmental Medicine, Karolinska 
      Institutet, Stockholm, Sweden.
FAU - Bottai, Matteo
AU  - Bottai M
AD  - Unit of Biostatistics, Institute of Environmental Medicine, Karolinska 
      Institutet, Stockholm, Sweden.
FAU - Soderberg-Lofdal, Karin
AU  - Soderberg-Lofdal K
AD  - Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska 
      Institutet, Stockholm, Sweden.
FAU - Bergquist, Annika
AU  - Bergquist A
AD  - Department of Medicine Huddinge, Unit of Gastroenterology and Rheumatology, 
      Karolinska Institutet, Stockholm, Sweden; Division of Hepatology, Department of 
      Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden. Electronic 
      address: annika.bergquist@ki.se.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20181115
PL  - United States
TA  - Clin Gastroenterol Hepatol
JT  - Clinical gastroenterology and hepatology : the official clinical practice journal 
      of the American Gastroenterological Association
JID - 101160775
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Cholagogues and Choleretics)
RN  - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
RN  - 0 (Immunosuppressive Agents)
RN  - 4Q81I59GXC (Mesalamine)
RN  - 724L30Y2QR (Ursodeoxycholic Acid)
RN  - MRK240IY2L (Azathioprine)
SB  - IM
CIN - Clin Gastroenterol Hepatol. 2020 May;18(5):1244-1245. PMID: 31593771
CIN - Clin Gastroenterol Hepatol. 2020 May;18(5):1245-1246. PMID: 31730911
MH  - Adult
MH  - Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
MH  - Azathioprine/*therapeutic use
MH  - Cholagogues and Choleretics/therapeutic use
MH  - Cholangitis, Sclerosing/complications/*drug therapy
MH  - Colitis, Ulcerative/complications/drug therapy
MH  - Crohn Disease/complications/drug therapy
MH  - Esophageal and Gastric Varices/epidemiology
MH  - Female
MH  - Gastrointestinal Hemorrhage/epidemiology
MH  - Humans
MH  - Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use
MH  - Immunosuppressive Agents/*therapeutic use
MH  - Inflammatory Bowel Diseases/complications/*drug therapy
MH  - Liver Transplantation/*statistics & numerical data
MH  - Male
MH  - Mesalamine/therapeutic use
MH  - Middle Aged
MH  - *Mortality
MH  - Proportional Hazards Models
MH  - Protective Factors
MH  - Registries
MH  - Sweden/epidemiology
MH  - Ursodeoxycholic Acid/therapeutic use
OTO - NOTNLM
OT  - 5-ASA
OT  - UDCA
OT  - cholangiocarcinoma
OT  - inflammatory bowel disease
EDAT- 2018/11/19 06:00
MHDA- 2020/10/29 06:00
CRDT- 2018/11/19 06:00
PHST- 2018/08/02 00:00 [received]
PHST- 2018/10/09 00:00 [revised]
PHST- 2018/11/02 00:00 [accepted]
PHST- 2018/11/19 06:00 [pubmed]
PHST- 2020/10/29 06:00 [medline]
PHST- 2018/11/19 06:00 [entrez]
AID - S1542-3565(18)31245-X [pii]
AID - 10.1016/j.cgh.2018.11.002 [doi]
PST - ppublish
SO  - Clin Gastroenterol Hepatol. 2019 Aug;17(9):1860-1866.e1. doi: 
      10.1016/j.cgh.2018.11.002. Epub 2018 Nov 15.