Editors' ChoiceClinical Trials

Polypharmacy repercussions

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Science Translational Medicine  18 Nov 2015:
Vol. 7, Issue 314, pp. 314ec200
DOI: 10.1126/scitranslmed.aad5911

People take blockbuster cholesterol-lowering statin drugs daily for years on end, so these medications likely have health consequences beyond their ability to lower heart disease risk in some patients. The most commonly prescribed drugs for lowering cholesterol, statins are known to inhibit the rate-limiting enzyme for cholesterol production, but they also have immunomodulatory activities, including powerful anti-inflammatory effects that might contribute to their clinical effectiveness. Thus, an important question is how long-term statin use might affect response to vaccine, which requires immune activation. Now, Black and colleagues evaluate the effects of statin use on responsiveness to influenza vaccination in the elderly.

Influenza vaccination is generally less effective in the elderly, but Black and colleagues found that statin use independently reduced flu vaccine responses. The authors performed a cross-sectional observational study with more than 5000 elderly participants of a comparative immunogenicity clinical trial on the influenza vaccine. By measuring hemagglutination-inhibiting mean titers to several influenza strains, the authors detected apparent immunosuppression in patients on chronic statin therapy but not in statin-free participants. It is not yet known how statin use might have affected the interpretation of previous studies related to age and vaccine effectiveness.

These findings could support a change in clinical recommendations related to vaccination of statin patients. But it is also a provocative reminder that meaningful interpretation of clinical data can be thwarted by a poor understanding of how various medications, vaccines, and chronic medical conditions interact with one another.

S. Black et al., Influence of statins on influenza vaccine response in elderly individuals. J. Infect. Dis. 10.1093/infdis/jiv456 (2015). [Full Text]

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