Use of atorvastatin in systemic lupus erythematosus in children and adolescents

Abstract

Objective Statins reduce atherosclerosis and cardiovascular morbidity in the general population, but their efficacy and safety in children and adolescents with systemic lupus erythematosus (SLE) are unknown. This study was undertaken to determine the 3-year efficacy and safety of atorvastatin in preventing subclinical atherosclerosis progression in pediatric-onset SLE. Methods A total of 221 participants with pediatric SLE (ages 10–21 years) from 21 North American sites were enrolled in the Atherosclerosis Prevention in Pediatric Lupus Erythematosus study, a randomized double-blind, placebo-controlled clinical trial, between August 2003 and November 2006 with 36-month followup. Participants were randomized to receive atorvastatin (n = 113) or placebo (n = 108) at 10 or 20 mg/day depending on weight, in addition to usual care. The primary end point was progression of mean-mean common carotid intima-media thickening (CIMT) measured by ultrasound. Secondary end points included other segment/wall-specific CIMT measures, lipid profile, high-sensitivity C-reactive protein (hsCRP) level, and SLE disease activity and damage outcomes. Results Progression of mean-mean common CIMT did not differ significantly between treatment groups (0.0010 mm/year for atorvastatin versus 0.0024 mm/year for placebo; P = 0.24). The atorvastatin group achieved lower hsCRP (P = 0.04), total cholesterol (P < 0.001), and low-density lipoprotein (P < 0.001) levels compared with placebo. In the placebo group, CIMT progressed significantly across all CIMT outcomes (0.0023–0.0144 mm/year; P < 0.05). Serious adverse events and critical safety measures did not differ between groups. Conclusion Our results indicate that routine statin use over 3 years has no significant effect on subclinical atherosclerosis progression in young SLE patients; however, further analyses may suggest subgroups that would benefit from targeted statin therapy. Atorvastatin was well tolerated without safety concerns.

Why are kids with lupus at an increased risk of cardiovascular disease?

“…Results showed no difference in coronary artery calcium, cIMT, carotid plaque, hsCRP, or markers of endothelial activation. In a similar study with a pediatric population, Schanberg et al [185] showed no effect of atorvastatin on the progression of cIMT over 36 months in patients with JSLE. Post hoc analysis showed some benefit in post-pubertal patients with higher hsCRP.…”

Does Renin‐Angiotensin System Blockade Protect Lupus Nephritis Patients From Atherosclerotic Cardiovascular Events? A Case–Control Study

“…Certain therapeutic 9 approaches, usually with statins, have been implemented for halting subclinical atherosclerosis in lupus patients with inconsistent results [12][13][14][15]. Other preventive strategies, such as ACEIs and ARBs, which have shown a significant benefit in at-risk populations [5], have not been tested in SLE patients.…”

Cardiovascular Events in Systemic Lupus Erythematosus: Mechanisms for the Accelerated Development of Atherosclerosis, Diagnosis, Correction Capabilities

“…Кроме того, применение аторвастати-на у педиатрического контингента больных с СКВ в те-чение 36 мес не повлияло на толщину КИМ, хотя уро-вень СРБ и липидный профиль действительно улучша-лись [93].…”