Statins may have role in tuberculosis prevention in patients with bronchiectasis, suggests study

"Statin treatment demonstrated a dose-dependent protective effect and was linked with a reduced risk of TB in bronchiectasis patients. These findings indicate that statins may play a role in reducing TB risk by modulating airway inflammation in this patient population," the researchers wrote.

According to the researchers, this is the first clinical study reporting an association between statin use and TB risk in patients with bronchiectasis. In a prior animal study, statins were revealed to have a potent adjunctive role to anti-TB drugs by intensifying their activity through phenocopying macrophage activation and regulating phagosomal maturation.

Chronic airway diseases have been associated with an increased TB risk, however, data is limited in bronchiectasis patients. Statins have been shown to exhibit anti-inflammatory effects by modulating the inflammatory response. Therefore, Kuang-Ming Liao, Department of Internal Medicine, Chi Mei Medical Center Chiali Branch, Tainan, Taiwan, and colleagues investigated whether statin treatment could reduce TB risk in patients with bronchiectasis.

For this purpose, the research team conducted a retrospective cohort study using a nationwide population database of bronchiectasis patients who did not receive statin treatment. The defined daily dose (DDD) of statin, current or past statin user and statin exposure time was measured for the impact of statin use.

The study's primary outcome was the incidence of new-onset tuberculosis. Considering of potential immortal time bias due to stain exposure time, Cox regression models with time-dependent covariates were employed to determine HRs for TB incidence among patients with bronchiectasis.

The study led to the following findings:

• Patients with bronchiectasis receiving statin treatment had a decreased risk of TB.
• After adjusting for age, sex, income, comorbidities and Charlson Comorbidity Index, statin users had a 0.59-fold lower risk of TB incidence compared with non-statin users.
• Compared with non-statin users, statin treatment was a protective factor against TB in users with a cumulative DDD greater than 180 per year, with an HR of 0.32.

In conclusion, the findings showed a reduced risk of tuberculosis with statins in bronchiectasis patients, exerting a dose-dependent protective effect. This protective effect was observed in patients of both sexes, different comorbidity levels, and all age groups.

The researchers suggest that healthcare providers should carefully assess the potential benefits of statin therapy in TB risk reduction while considering personal patient factors before incorporating statin use into their clinical practice.

"Nonetheless, there is a need for further prospective studies to obtain more information on the relationship between statin use and the risk of TB development," the researchers concluded.

Reference:

Liao, M., Lee, S., Wu, C., Shu, C., & Ho, H. (2024). Association between statin use and tuberculosis risk in patients with bronchiectasis: A retrospective population-based cohort study in Taiwan. BMJ Open Respiratory Research, 11(1). https://doi.org/10.1136/bmjresp-2023-002077