Pravastatin May Have Protective Effect Against Active Tuberculosis Infection

Risk for active tuberculosis (TB) may be reduced with the use of statins. This finding was published in a letter to the editor in the Journal of Infectious Diseases.¹

Previously published population-based nested case-control data from 1999 to 2011 were analyzed for this study. Patients with a new TB diagnosis were randomly matched by age and gender with 100 control individuals. The study authors assessed whether the use of the 5 most common statins (atorvastatin, simvastatin, rosuvastatin, fluvastatin, and pravastatin) was associated with TB infection rates.

A total of 8164 individuals were diagnosed with TB, 2.2% of whom were undergoing treatment with statins. Comparatively, 2.7% of participants in the control group were undergoing treatment with statins.

Overall, the use of statins decreased the risk for receiving a diagnosis of active TB (adjusted rate ratio [aRR], 0.79; 95% CI, 0.68-0.92; P <.05).

Stratified by statin type, there was no significant protective effect observed for users of atorvastatin (n=67; aRR, 0.81; 95% CI, 0.64-1.04), simvastatin (n=36; aRR, 0.84; 95% CI, 0.61-1.18), rosuvastatin (n=28; aRR, 0.90; 95% CI, 0.62-1.32), or fluvastatin (n=18; aRR, 0.68; 95% CI, 0.43-1.09).

The protective effect of treatment with a statin against active TB infection was driven by the patients who underwent treatment with pravastatin (n=11; aRR, 0.54; 95% CI, 0.30-0.98; P <.05). However, the mechanistic difference among the varying statins that may be driving this pattern of protection remains unclear.

These results were similar to previously published data from Korea, in which individuals undergoing treatment with statins were at decreased risk for TB compared with those not undergoing treatment with statins (hazard ratio [HR], 0.67; 95% CI, 0.46-0.98).² Similarly, a meta-analysis identified decreased risk for TB among individuals in the general population undergoing treatment with a statin (pooled RR, 0.60; 95% CI, 0.50-0.71).

This analysis was limited by its low simple size, especially among specific statin types.

These findings indicate that larger trials are needed to assess whether statins may be protective against active TB infection.

References

1. Lai CC, Tehrani B, Yungtum G, Hsu WT, Lee CC. Association between the use of statins and risk of tuberculosis: a real-world analysis. J Infect Dis. Published online February 8, 2021. doi:10.1093/infdis/jiab077

2. Duan H, Liu T, Zhang X, Yu A, Cao Y. Statin use and risk of tuberculosis: a systemic review of observational studies. Int J Infect Dis. 2020;93:168-174. doi:10.1016/j.ijid.2020.01.036