Statin use is associated with lower rates of stricture development in patients with Crohn's disease: a propensity score-matched study of two nationwide population databases

BACKGROUND: Intestinal stricture affects over half of patients with Crohn's disease (CD) and has significant associated morbidity. Statins possess both anti-inflammatory and anti-fibrotic properties and may improve CD outcomes, although current data are limited. This study assessed whether statin use is associated with a reduced risk of new stricture development in CD in a diverse US population, and evaluated the role of IBD therapy in any association. METHODS: We conducted a retrospective cohort study comparing patients with CD with and without statin exposure using the EVERSANA US electronic health records database. Findings were independently validated in a second database (Merative MarketScan). Patient demographics, co-morbidities, laboratory measurements, and CD medications were assessed. The primary outcome was development of new stricture as defined by a composite endpoint of an encounter for stricture diagnosis or occurrence of a stricture-related procedure. Propensity score (PS)-matched Cox proportional hazards models were used to estimate associations. RESULTS: The EVERSANA cohort comprised 1210 statin recipients and 25 000 non-statin users. Over a mean follow-up of 3.8 years, PS-matched statin users had a 28% reduction in the risk of new-onset stricture (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.53-0.99, P = .043). The Merative cohort contained 9577 statin users and 56 918 non-statin users. Over a mean follow-up of 3.6 years, PS-matched statin use had a 29% risk reduction in new-onset stricture (HR 0.71, 95% CI 0.66-0.77, P < .001). CONCLUSIONS: Statin use is independently associated with reduced progression to stricture formation in two PS-matched large and diverse cohorts of patients with CD.