Statin Use is Associated With Lower Odds of IBD-Related Surgery Among Patients With Moderate-to-Severe Inflammatory Bowel Disease

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BACKGROUND: Statins may have anti-inflammatory activity in inflammatory bowel disease (IBD). We aimed to investigate any impact of statins on disease progression in moderate-to-severe IBD. METHODS: We conducted a retrospective cohort study of patients with moderate-to-severe IBD and at least 2 outpatient visits between 2000 and 2023 at a large, urban hospital system. Using the Mount Sinai Data Warehouse, we collected data on biologic, small molecule, or immunomodulator use for IBD, cardiovascular (CV) medications, and International Classification of Diseases codes designating IBD hospitalizations and surgeries. Our primary outcome was IBD-related surgery in statin users and nonusers, adjusting for IBD and CV risk. Our secondary outcomes were IBD-related hospitalization, advanced therapy persistence, and time to IBD surgery. Multivariable regression analyses and propensity score matching were used to adjust for relevant clinical variables. Cox regression analysis assessed time to surgery in statin users versus nonusers. RESULTS: We identified 2421 patients with moderate-to-severe IBD who had longitudinal outpatient follow-up: 375 statin users and 2046 nonusers. Statin users had fewer IBD-related surgeries (5% vs 9%; P = .007). Statin users had a trend, but no significant difference, toward fewer hospitalizations per person (0.73 hospitalizations/person among statin users and 0.93 in nonusers; P = .09), although no difference in therapy persistence was noted. Statin users had lower hazards of surgery at 16 149 patient-years of follow-up (adjusted hazard ratio, 0.47; 95% confidence interval [CI], 0.26-0.85; P = .012). Propensity-adjusted odds ratios (ORs) showed a lower risk of IBD surgery (adjusted OR, 0.51; 95% CI, 0.27-0.95; P = .034) but not of IBD hospitalization (adjusted OR, 0.91; 95% CI, 0.73-1.14; P = .424) among statin users. CONCLUSIONS: Patients with moderate-severe IBD using statins were less likely to experience IBD-related surgery in a real-world, electronic health record-based cohort.

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