Stopping statins for terminal patients doesn't hasten death and may improve their quality of life, a trial showed.

The 60-day mortality rate didn't differ significantly after discontinuation of long-standing statin therapy compared with staying on it (23.8% versus 20.3%, P=0.60),Amy Abernethy, MD, PhD, of Duke University Medical Center, and colleagues found.

Median survival actually was numerically longer in the statin discontinuation group at 229 days compared with 190 in the continuation group, although not statistically significant at P=0.6.

Moreover, quality of life as a secondary endpoint favored stopping the lipid-lowering drug (HR 0.26, 95% CI 0.02-0.60), the researchers reported here at theAmerican Society of Clinical Oncology meeting.

"We still think this is a patient-centered question," Abernethy said at a press conference. "However, as clinicians we can now feel confident that we're not harming our patients by making this decision."

It can be a very difficult decision whether to "rock the boat" by changing medications patients have been stable on for a long period of time, noted Patricia Ganz, MD, of UCLA and chair of the press conference.

"All of those medications are given for prevention, but when someone has a reduced life expectancy, prevention doesn't really make sense," she said, agreeing with Abernethy's conclusion.

Statins have been associated with better survival in some other cancer types, such as prostate and liver cancer, but this is a different stage of management when there's a meaningful reason to conclude patients are in their final weeks and months of life, Abernethy pointed out.

Her unblinded, pragmatic trial included 381 patients with illness (cancer in 49%) expected to end life in 1 month to 1 year, who had been taking a statin for at least 3 months for primary or secondary prevention.

Satisfaction with care and total symptoms reported by patients showed modest, nonsignificant decreases with cessation of statins.

One potential reason is that patients often have trouble swallowing at this stage of illness, Abernethy pointed out.

Stopping statins appeared to prompt discussions about stopping other medications too, she noted.

Polypharmacy is substantial in these patients, but stopping statins decreased the total number of meds slightly (10.1 versus 10.8, P=0.034).

The cost savings was more substantial, amounting to $3.37 saved per patient per day from stopping statins, or $716.46 per patient across their lifespan in the trial.

Extrapolated to the current U.S. population, that would translate to a total of $603 million in savings, or $1 billion for the projected population of 2040.

Statins used in the trial were mostly brand at the time of the study; a shift to generic would about halve the savings, Abernethy noted.

Source: www.medpagetoday.com