The effect of statin therapy on disease-related outcomes in idiopathic pulmonary fibrosis: A systematic review and meta-analysis

Background. - Idiopathic pulmonary fibrosis is a progressive disease and antifibrotic therapies do notreverse existing fibrosis. There has been emerging evidence of potential role for statins in idiopathicpulmonary fibrosis. The aim of this review is to synthesise the evidence on the efficacy of statins in idiopathic pulmonary fibrosis, focusing on associations with all-cause mortality, disease-specific mortalityand change in pulmonary function. Methods. - Medline and Embase were reviewed to identify relevant publications. Studies were selectedif they examined disease-related outcomes including mortality, pulmonary function and adverse eventsin people with idiopathic pulmonary fibrosis receiving statin therapy. Results. - Five studies with a total of 3407 people with IPF were selected and analysed. The overall riskof bias of five included studies was moderate to serious. In the fixed effect meta-analysis, statin use wasassociated with a reduction in mortality (RR 0.8; 95% CI 0.72-0.99). However, in the random effects model, there was no longer any significant association between statin use and all-cause mortality (RR 0.87; 95% CI 0.68-1.12). There was no statistically significant association between statin use and decline in FVC % predicted. Conclusion. - There is currently insufficient evidence to conclude the effect of statin therapy on diseaserelated outcomes in idiopathic pulmonary fibrosis. Considering the limitations of available literature, wewould recommend a prospective cohort study with capture of dosage and preparation of statin, statinadherence and use of concurrent antifibrotic treatment. PROSPERO registration number. - CRD42019122745.