Atorvastatin for the Treatment of Plaque-type Psoriasis

Toktam Faghihi, Mania Radfar, Zohre Mehrabian, Amir Hoshang Ehsani, and Mohsen Rezaei Hemami,

Disclosures

Pharmacotherapy. 2011;31(11):1045-1050. 

In This Article

Abstract and Introduction

Abstract

Study Objective. To explore the efficacy and safety of oral atorvastatin for the treatment of plaque-type psoriasis.
Design. Prospective, randomized, double-blind, placebo-controlled study.
Setting. University-affiliated psoriasis outpatient clinic in Iran.
Patients. Forty-two patients aged 16–60 years with a diagnosis of acute or chronic plaque-type psoriasis with body surface area (BSA) involvement of greater than 10% were enrolled; 40 completed the study.
Intervention. Oral atorvastatin 40 mg/day (20 patients) or placebo (20 patients) was administered for 12 weeks; patients' topical therapies with emollients, keratolytics, and/or class V corticosteroids were continued during the study period.
Measurements and Main Results. The Psoriasis Area and Severity Index (PASI) and percentage BSA involvement were used to assess the efficacy of therapy. Mean ± SD baseline PASI scores were 7.42 ± 1.90 and 6.92 ± 1.76 in the atorvastatin and placebo groups, respectively. The primary outcomes were the degree of change in PASI scores and percentage BSA involvement from baseline to week 12. Significant improvement in psoriasis lesions was observed in both the atorvastatin and placebo groups (p<0.001 for both groups). A 75% improvement in PASI score (PASI 75) was achieved in 8 patients (40%) in the atorvastatin group and 7 patients (35%) in the placebo group. However, no statistically significant differences were noted between the two treatment groups in mean PASI score, percentage BSA involvement, and PASI 75. In terms of adverse effects, atorvastatin was well tolerated.
Conclusion. Oral atorvastatin 40 mg/day was not associated with therapeutic benefit when given to patients with baseline PASI scores less than 12 who were also treated with standard topical therapies. Additional trials are needed to elucidate the place of statins for the treatment of psoriasis. A larger follow-up study, as well as testing atorvastatin in patients with more intensive disease characterized by high PASI scores, is needed. Studies using higher atorvastatin doses or dose-ranging studies should also be performed.

Introduction

Psoriasis, a common skin disease, is a chronic inflammatory condition generally characterized by erythematous papules and plaques.[1–3] Although regarded primarily as a disease of hyperproliferation, its pathogenesis has also proved to be immune mediated. This concept contributed to the development of novel immunosuppressive therapies that target activated T cells and inflammatory cytokines to control psoriasis.[4]

The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are a potent class of lipid-lowering agents. Beyond cholesterol-lowering effects, statins have many antiinflammatory, vascular endothelial, and immunomodulatory actions.[5–8] These pleiotropic or cholesterolindependent properties have promoted the potential role of statins in several autoimmune and inflammatory disorders.[9]

A large body of evidence indicates that patients with psoriasis have increased cardiovascular comorbidities.[10–16] Thus, it has been proposed that statins may be a valuable therapeutic option in this population, targeting both psoriasis and the associated cardiovascular risks.[3] Moreover, statins are safe and inexpensive drugs compared with the current systemic therapies for psoriasis

There are ample reviews in the literature regarding the potential therapeutic value of statins for the treatment of psoriasis.[3,16–20] However, we found no double-blind clinical trial evaluating the efficacy of atorvastatin in the pharmacotherapy of psoriasis. Therefore, the aim of our study was to prospectively investigate the efficacy and safety of atorvastatin in patients with psoriasis.

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