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Statin therapy in systemic lupus erythematosus: a meta-analysis of disease activity and inflammatory biomarkers
Suhai Qian1, Jingyi Wu1, Chao Hu1
1School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China.
Insights
Statin therapy may reduce systemic lupus erythematosus (SLE) disease activity and inflammation, particularly in younger patients. Further research is needed to confirm these findings and identify optimal patient populations.
Area of Science:
- Rheumatology
- Cardiovascular Medicine
- Clinical Pharmacology
Background:
- Dyslipidaemia is a significant contributor to the pathogenesis and cardiovascular risk in patients with systemic lupus erythematosus (SLE).
- The impact of statin therapy on SLE disease activity remains a subject of ongoing debate and investigation.
Purpose of the Study:
- To systematically evaluate the effects of statin therapy on disease activity and inflammatory markers in patients with SLE.
- To synthesize evidence from existing studies to clarify the role of statins in managing SLE.
Main Methods:
- A comprehensive systematic literature search was conducted following PRISMA 2020 guidelines up to November 2024.
- Meta-analysis was performed using R software, analyzing data from 12 included studies.
- Outcomes assessed included SLE Disease Activity Index (SLEDAI), C-reactive protein (CRP), interleukin-6 (IL-6), and erythrocyte sedimentation rate (ESR).
Main Results:
- Statins significantly reduced SLEDAI in before-after studies but not in parallel controlled trials.
- A notable reduction in SLEDAI was observed in patients younger than 40 years.
- Statins demonstrated a significant lowering effect on CRP, IL-6 (after outlier exclusion), and ESR levels.
Conclusions:
- Statin therapy shows potential in reducing disease activity and inflammation in SLE patients, especially those under 40.
- Significant heterogeneity across studies highlights the need for rigorously designed, age-stratified randomized controlled trials.
- Future research should aim to confirm these findings and define specific patient populations who would benefit most from statin therapy.
Objective:
Dyslipidaemia in systemic lupus erythematosus (SLE) contributes to pathogenesis and cardiovascular risk. The effect of statin therapy on SLE disease activity remains controversial. This meta-analysis systematically evaluates the impact of statins on SLE activity and inflammatory markers.
Methods:
This study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A systematic literature search across multiple databases was conducted up to 13 November 2024. Study selection, data extraction and quality assessment were performed independently by two reviewers. Meta-analysis was conducted using R software, evaluating outcomes including SLE Disease Activity Index (SLEDAI), C-reactive protein (CRP), interleukin-6 (IL-6) and erythrocyte sedimentation rate (ESR).
Results:
From 3596 identified records, 12 studies were included. Statins significantly reduced SLEDAI in controlled before-after studies (weighted mean difference (WMD)=-0.70, 95% CI -1.16 to -0.23; p=0.0037), but not in parallel controlled trials (WMD=-0.58, 95% CI -1.74 to 0.59; p=0.330; I² = 81.1%). Subgroup analysis showed a pronounced reduction in patients with a mean age <40 years (WMD=-1.60, 95% CI -1.98 to -1.22; p<0.001). Statins lowered CRP in both controlled before-after studies (standardised mean difference (SMD)=-0.38, 95% CI -0.73 to -0.03; p=0.032) and parallel controlled trials (SMD=-1.45, 95% CI -2.84 to -0.07; p=0.040). After excluding an outlier, the reduction in IL-6 became significant (SMD=-0.32, 95% CI -0.63 to -0.00; p=0.048). ESR was also reduced (SMD=-1.81, 95% CI -3.54 to -0.08; p=0.0406). No significant publication bias was detected.
Conclusion:
Statin therapy may reduce disease activity and inflammation in SLE, with a consistent benefit observed in patients with a mean age <40 years. Significant heterogeneity underscores the need for future rigorously designed, age-stratified randomised trials to confirm these findings and define the target patient population.
Prospero Registration Number:
CRD42025630267.
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