Angiotensin converting enzyme inhibitors (ACEI) and hydroxymethylglutaryl coenzyme-A (HMG-CoA) reductase inhibitors (statins) possess antifibrotic effects and therefore they may have a role in the treatment of IPF/UIP. We assessed the effect of these medications on patients with IPF/UIP.
Four-hundred and seventy seven patients with IPF/UIP seen at Mayo Clinic Rochester from January 1, 1994 to December 31, 1996 met the inclusion criteria. Abstracted data included: age, sex, vital status, clinical and laboratory features, medications, CT scan findings, and lung biopsy results. The medications at index visit date were reviewed to see if the patients were on statins, ACEI or angiotensin receptor blockade (ARB). For survival analysis, time zero was defined as the index visit.
Eighty-two (17%) patients were on statins or ACE inhibitors. Thirty-five (7%) patients were on statins, 52 (11%) on ACEI, 5 (1%) were on both, and 2 (1%) on ARB. There was no difference in survival when comparing those patients on statin therapy versus those who were not with median survival of 2.9 years for both groups (p=0.683). Similarly, there was no difference in survival when comparing those patients on ACEI therapy versus those who were not with median survival of 2.2 years and 2.9 years, respectively (p=0.114). When comparing survival for those patients on either statins or ACEI therapy versus those not the median survival for subjects on one of the drugs was 2.5 years compared to 3.0 years for those not on either drug (p=0.094). After adjusting for age, gender, recommended treatment for IPF, smoking status, prior oxygen use, FEV1, and DLCO there was still no difference between those subjects on either statins, ACIE or both versus those who were not.CONCLUSIONS: These data do not suggest a beneficial effect of statin or ACEI therapy on survival of patients with idiopathic pulmonary fibrosis.
Until prospective randomized trials show that statins or ACEI improve survival we do not recommend this treatment for patients with IPF/UIP.
H.F. Nadrous, None.