Background Statins have been demonstrated to reduce disease activity in rheumatoid arthritis (RA) patients. There is growing evidence that another class of hypolipidemic drugs – PPARalpha agonists, or fibrates, may play a role in the treatment of RA. There is a lack of data on comparative effects of statins and fibrates in RA.
Objectives To evaluate comparative anti-inflammatory effects of fenofibrate and simvastatin in patients with active RA.
Methods We retrospectively compared clinical efficacy of fenofibrate and simvastatin in similar groups of patients with active RA who had participated in two respective open-label before-after clinical trials performed in a single center. The main eligibility criteria were fulfillment of ACR criteria and DAS28 > 3.2. Each group consisted of 33 patients. Patients received treatment with 145 mg of micronised fenofibrate or 40 mg simvastatin per day for 12 weeks. Evaluations were made at baseline and at weeks 4, 8 and 12. Clinical efficacy outcomes recorded were: DAS28, individual DAS28 components, ACR responses, HAQ, pain levels (VAS), and ESR. Longitudinal changes in clinical efficacy parameters were compared between groups using generalized estimating equations (GEE). The models were adjusted for baseline patients’ age, disease duration, concomitant disease modifying antirheumatic drugs use, and baseline disease activity.
Results The mean duration of disease was 8.2 (IQR 2.4,19) years and 9 (IQR 6,13) years in fenofibrate and simvastatin groups, respectively. The fenofibrate group had slightly lower baseline disease activity (6.3 (SD 0.8) vs 6.8 (SD 0.8), p=0.009). Moderate EULAR response was achieved in 17 (51.5% ) patients receiving fenofibrate and 11 (33.3)% patients who were prescribed simvastatin. Using GEE analysis, fenofibrate treatment was shown to be associated with a greater reduction in DAS28, swollen joint count, and patient’s assessment of general health. There was also a trend towards improvement in ESR in fenofibrate group (Table).
Conclusions The results of this retrospective analysis suggest that in active RA patients fenofibrate may have more pronounced anti-inflammatory effects that simvastatin. These findings have to be confirmed in a randomized study.
Disclosure of Interest None Declared
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