Statin therapy may reduce risk for multiple myeloma mortality
Use of statins appeared to reduce the risk for all-cause and multiple myeloma–specific mortality, according to an analysis of data from U.S. veterans with multiple myeloma.
“It has been suggested from prior studies that statins have a role in improving outcomes, specifically survival, in patients with cancer,” Kristen Marie Sanfilippo, MD, MPHS, assistant professor in the department of medicine, hematology division at Washington University School of Medicine, told HemOnc Today. “Statins act on the mevalonate pathway, the same pathway nitrogen-containing bisphosphonates act on. Prior prospective trials have shown a survival benefit with nitrogen-containing bisphosphonates in multiple myeloma.”
Based on this evidence, Sanfilippo and colleagues hypothesized that statin use would be associated with improved survival in patients with multiple myeloma. Researchers used the Veterans Administration Central Cancer Registry to identify 4,957 patients diagnosed with multiple myeloma between 1999 and 2013. Of these patients, 2,294 received statins, defined as any prescription for a statin within 3 months before or any time after cancer diagnosis.
Median follow-up was 34 months for statin users and 26 months for statin nonusers.
Researchers were able to analyze multiple myeloma–specific mortality in 3,284 of the patients, 1,415 of whom received statin therapy. Patients who reported statin use were more likely to be older, white, have higher BMIs, to have been diagnosed after 2006, and to have differences in baseline albumin and hemoglobin levels. They also were more likely to have medical comorbidities, such as diabetes and ischemic heart disease.
Median OS was 39.5 months among statin users and 27 months among nonusers. After adjusting for confounders, statin use was associated with a 21% reduction in risk for all-cause mortality (HR = 0.79; 95% CI, 0.73-0.86) and a 24% reduction in multiple myeloma–specific mortality (HR = 0.76; 95% CI, 0.67-0.86).
“Disease-specific therapies and stem cell transplant will remain the mainstay of care in multiple myeloma,” Sanfilippo said. “However, if statins show efficacy in prospective trials, they would offer an adjunctive means to improve outcomes in a disease with no current curative therapy.”
Factors associated with poorer all-cause and multiple myeloma–specific survival included older age, BMI less than 18.5, higher Charlson comorbidity index score, hemoglobin less than 10 g/dL, estimated glomerular filtration rate less than 30 mL/min/1.73 m2, albumin less than 3 g/dL and treatment with pamidronate.
Statin use also appeared to reduce risk for the development of a skeletal-related event (adjusted HR = 0.69; 95% CI, 0.59-0.8).
The association with statin use and improved survival persisted in analyses adjusted for race and appeared to increase with longer statin use.
Researchers acknowledged that the registry may have had misclassification of statin use due to patient noncompliance. They also noted that although they adjusted for factors that could lead to confounding, residual and unmeasured differences could exist between statin users and nonusers.
More research on this association is necessary, Sanfilippo said.
“Moving forward, it is important to corroborate our findings in a prospective trial,” Sanfilippo said. “In addition, we are investigating the role of statins in monoclonal gammopathy of undetermined significance, a multiple myeloma precursor state.” – by Alexandra Todak
For more information:
Kristen Marie Sanfilippo, MD, MPHS, can be reached at Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8125, St Louis, MO 63110; e-mail: firstname.lastname@example.org.
Disclosure: Sanfilippo reports no relevant financial disclosures. One researcher reports consultant/advisory roles with or research funding from Allos Therapeutics, Bristol-Myers Squibb, Celgene, Kyowa Hakko Kirin, Millennium and Seattle Genetics, as well as travel expenses from Flatiron Health and expert testimony provided for Pharmacia.