Statin Use Linked with Increased MDS Survival

Statin use was associated with a decreased risk of progression to acute myeloid leukemia (AML) and improved survival in patients with myelodysplastic syndromes (MDS), according to a retrospective study.

Amber Afzal, MD, MSCI, of Washington University in St. Louis and colleagues conducted the large retrospective study and published their findings in Blood.

While patients with MDS currently have “limited treatment options that suppress inflammation and reduce mortality,” statins “present an attractive class of drugs in this situation,” Dr. Afzal and colleagues wrote.

They used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to identify a national cohort of patients with MDS and evaluate the effect of statins on overall survival (OS) and progression to AML.

The researchers used the SEER-Medicare database to identify 56,768 consecutive patients with MDS between 2007 and 2018. They determined 12,674 patients were eligible for inclusion, finding that 6,712 (53%) of those patients started using statins when they were diagnosed with MDS. The final analysis set included 657 patients who used statins and 1,971 patients who did not use statins.

The median OS for the entire cohort was 16 months. Patients who used statins had a significantly higher median OS (27 months; 95% CI, 18-32) than those who did not (15 months; 95% CI, 14-16; P<.001).

An unadjusted analysis showed that statin use was associated with a 36% decrease in hazard for death (hazard ratio [HR], 0.64; 95% CI, 0.46-0.89; P=.008). When the analysis was adjusted for demographics, MDS risk, and MDS treatment, statin use was associated with a 38% decrease in hazard for death (adjusted HR, 0.62; 95% CI, 0.45-0.87; P=.005).

Nearly one-fifth (17.7%) of patients progressed to AML during the study period. An unadjusted analysis showed statin use was associated with a 22% decrease in the risk of progression to AML (HR, 0.78; 95% CI, 0.63-0.97; P=.023). In an analysis adjusted for demographics, MDS risk, and MDS treatment, statin use was associated with a 20% decrease in the risk of progression to AML (adjusted HR, 0.80; 95% CI, 0.64-1.00; P=.045).

Dr. Afzal and colleagues also found that “higher-risk categories of MDS and requirement for MDS-redirected treatments predicted progression to AML.”

Most patients (82.2%) died during the study period, with 41.3% dying from MDS or another malignancy and 14% dying from cardiovascular events.

Overall, the study showed starting statin therapy at MDS diagnosis was associated with a 38% improvement in OS, which was “higher than that observed for general population,” the study’s authors wrote.

“Interestingly, statins also reduced progression to leukemia and mortality from noncardiovascular causes, alluding to their anticancer potential,” Dr. Afzal and colleagues wrote. “MDS-directed treatments predicted higher mortality and risk of progression to AML in this study. This is likely because requirement for MDS-directed treatments is a marker for aggressive disease in this analysis.”

The study was limited by its retrospective nature and its authors emphasized that the results should be “confirmed in future randomized trials” of patients with MDS.

Reference

Afzal A, Fiala MA, Jacoby MA, Walter MJ. Statin use in myelodysplastic syndromes is associated with a better survival and decreased progression to leukemia. Blood Adv. 2023. doi:10.1182/bloodadvances.2023009818