Simvastatin does not exhibit therapeutic anti-inflammatory effects in asthma

Background: Statins lower cholesterol and also exhibit anti-inflammatory properties. In vitro and animal studies have suggested they may be useful for the treatment of a number of inflammatory conditions. Objective: To evaluate the in vivo therapeutic potential of simvastatin as an anti-inflammatory agent in patients with asthma. Methods: Potential signal from treatment effect was optimized by withdrawing all anti-inflammatory treatment for the duration of the study. Participants received 1 month of daily simvastatin and 1 month of daily placebo in a randomized, double-blind crossover trial. A total of 16 patients completed per protocol. Asthmatic inflammation was evaluated by measuring exhaled tidal nitric oxide, alveolar nitric oxide, sputum and peripheral eosinophil count, methacholine hyperresponsiveness, salivary eosinophilic cationic protein, and C-reactive protein. Measurements of dynamic and static lung volumes and of cholesterol were also made. Results: After initial withdrawal of usual asthma medication, there was a 1.43 geometric mean fold increase (ie, 43% difference) in fraction of exhaled nitric oxide (95% CI, 1.15 to 1.78; P =.004). Compared with placebo, simvastatin led to a 0.86 geometric mean fold decrease (95% Cl, 0.7 to 1.04; P = .15) in exhaled nitric oxide (ie, a 14% difference) and a-0.18 doubling dilution shift (95% CI, -1.90 to 1.55; P = 1.0) in methacholine hyperresponsiveness. There were no significant differences in other inflammatory outcomes, lung volumes, or airway resistance between simvastatin and placebo. Treatment with simvastatin led to a significant reduction (P < .005) of total and low-density lipoprotein cholesterol. Conclusion: There is no evidence to suggest simvastatin has anti-inflammatory activity in patients with asthma. Clinical implications: Simvastatin is not useful for the treatment of asthma.