Simvastatin reduces vaso‐occlusive pain in sickle cell anaemia: a pilot efficacy trial
Summary Sickle cell anaemia (SCA) is a progressive vascular disease characterized by episodic vaso‐occlusive pain. Despite the broad impact of inflammation on acute and chronic clinical manifestations of SCA, no directed anti‐inflammatory therapies currently exist. Statins are cholesterol‐lowering a...
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| Published in | British journal of haematology Vol. 177; no. 4; pp. 620 - 629 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Blackwell Publishing Ltd
01.05.2017
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| Subjects | |
| Online Access | Get full text |
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| Abstract | Summary
Sickle cell anaemia (SCA) is a progressive vascular disease characterized by episodic vaso‐occlusive pain. Despite the broad impact of inflammation on acute and chronic clinical manifestations of SCA, no directed anti‐inflammatory therapies currently exist. Statins are cholesterol‐lowering agents shown to confer protection from vascular injury by suppressing inflammation. We previously documented a reduction in soluble biomarkers of inflammation in patients with sickle cell disease treated with simvastatin. To determine the potential clinical efficacy of simvastatin, we treated 19 SCA patients with single daily dose simvastatin for 3 months and assessed changes from baseline in the frequency and intensity of diary‐reported pain and levels of circulating nitric oxide metabolites (NOx), high sensitivity C‐reactive protein (hs‐CRP), vascular cell adhesion molecule 1 (VCAM‐1), intercellular adhesion molecule 1 (ICAM‐1), ICAM‐3, E‐selectin, and vascular endothelial growth factor (VEGF). Treatment with simvastatin resulted in a significant reduction in the frequency of pain (P = 0·0003), oral analgesic use (P = 0·003) and circulating hs‐CRP (P = 0·003), soluble (s)E‐selectin (P = 0·01), sICAM‐1 (P = 0·02), sICAM‐3 (P = 0·02) and sVEGF (P = 0·01). Simvastatin had no effect on pain intensity or levels of NOx, sP‐selectin and sVCAM‐1. The observed reductions in pain rate and markers of inflammation were greatest in subjects receiving hydroxycarbamide (HC), suggesting a synergistic effect of simvastatin. These results provide preliminary clinical data to support a larger trial of simvastatin in SCA. |
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| AbstractList | Sickle cell anaemia (SCA) is a progressive vascular disease characterized by episodic vaso-occlusive pain. Despite the broad impact of inflammation on acute and chronic clinical manifestations of SCA, no directed anti-inflammatory therapies currently exist. Statins are cholesterol-lowering agents shown to confer protection from vascular injury by suppressing inflammation. We previously documented a reduction in soluble biomarkers of inflammation in patients with sickle cell disease treated with simvastatin. To determine the potential clinical efficacy of simvastatin, we treated 19 SCA patients with single daily dose simvastatin for 3 months and assessed changes from baseline in the frequency and intensity of diary-reported pain and levels of circulating nitric oxide metabolites (NOx), high sensitivity C-reactive protein (hs-CRP), vascular cell adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1), ICAM-3, E-selectin, and vascular endothelial growth factor (VEGF). Treatment with simvastatin resulted in a significant reduction in the frequency of pain (p=0.0003), oral analgesic use (p=0.003) and circulating hs-CRP (p=0.003), soluble (s)E-selectin (p=0.01), sICAM-1 (p=0.02), sICAM-3 (p=0.02) and sVEGF (p=0.01). Simvastatin had no effect on pain intensity or levels of NOx, sP-selectin and sVCAM-1. The observed reductions in pain rate and markers of inflammation were greatest in subjects receiving hydroxycarbamide (HC), suggesting a synergistic effect of simvastatin. These results provide preliminary clinical data to support a larger trial of simvastatin in SCA. Sickle cell anaemia ( SCA ) is a progressive vascular disease characterized by episodic vaso‐occlusive pain. Despite the broad impact of inflammation on acute and chronic clinical manifestations of SCA , no directed anti‐inflammatory therapies currently exist. Statins are cholesterol‐lowering agents shown to confer protection from vascular injury by suppressing inflammation. We previously documented a reduction in soluble biomarkers of inflammation in patients with sickle cell disease treated with simvastatin. To determine the potential clinical efficacy of simvastatin, we treated 19 SCA patients with single daily dose simvastatin for 3 months and assessed changes from baseline in the frequency and intensity of diary‐reported pain and levels of circulating nitric oxide metabolites ( NO x), high sensitivity C‐reactive protein (hs‐ CRP ), vascular cell adhesion molecule 1 ( VCAM ‐1), intercellular adhesion molecule 1 ( ICAM ‐1), ICAM ‐3, E‐selectin, and vascular endothelial growth factor ( VEGF ). Treatment with simvastatin resulted in a significant reduction in the frequency of pain ( P = 0·0003), oral analgesic use ( P = 0·003) and circulating hs‐ CRP ( P = 0·003), soluble (s)E‐selectin ( P = 0·01), sICAM ‐1 ( P = 0·02), sICAM ‐3 ( P = 0·02) and sVEGF ( P = 0·01). Simvastatin had no effect on pain intensity or levels of NO x, sP ‐selectin and sVCAM ‐1. The observed reductions in pain rate and markers of inflammation were greatest in subjects receiving hydroxycarbamide ( HC ), suggesting a synergistic effect of simvastatin. These results provide preliminary clinical data to support a larger trial of simvastatin in SCA. Sickle cell anaemia (SCA) is a progressive vascular disease characterized by episodic vaso-occlusive pain. Despite the broad impact of inflammation on acute and chronic clinical manifestations of SCA, no directed anti-inflammatory therapies currently exist. Statins are cholesterol-lowering agents shown to confer protection from vascular injury by suppressing inflammation. We previously documented a reduction in soluble biomarkers of inflammation in patients with sickle cell disease treated with simvastatin. To determine the potential clinical efficacy of simvastatin, we treated 19 SCA patients with single daily dose simvastatin for 3 months and assessed changes from baseline in the frequency and intensity of diary-reported pain and levels of circulating nitric oxide metabolites (NOx), high sensitivity C-reactive protein (hs-CRP), vascular cell adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1), ICAM-3, E-selectin, and vascular endothelial growth factor (VEGF). Treatment with simvastatin resulted in a significant reduction in the frequency of pain (P = 0·0003), oral analgesic use (P = 0·003) and circulating hs-CRP (P = 0·003), soluble (s)E-selectin (P = 0·01), sICAM-1 (P = 0·02), sICAM-3 (P = 0·02) and sVEGF (P = 0·01). Simvastatin had no effect on pain intensity or levels of NOx, sP-selectin and sVCAM-1. The observed reductions in pain rate and markers of inflammation were greatest in subjects receiving hydroxycarbamide (HC), suggesting a synergistic effect of simvastatin. These results provide preliminary clinical data to support a larger trial of simvastatin in SCA.Sickle cell anaemia (SCA) is a progressive vascular disease characterized by episodic vaso-occlusive pain. Despite the broad impact of inflammation on acute and chronic clinical manifestations of SCA, no directed anti-inflammatory therapies currently exist. Statins are cholesterol-lowering agents shown to confer protection from vascular injury by suppressing inflammation. We previously documented a reduction in soluble biomarkers of inflammation in patients with sickle cell disease treated with simvastatin. To determine the potential clinical efficacy of simvastatin, we treated 19 SCA patients with single daily dose simvastatin for 3 months and assessed changes from baseline in the frequency and intensity of diary-reported pain and levels of circulating nitric oxide metabolites (NOx), high sensitivity C-reactive protein (hs-CRP), vascular cell adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1), ICAM-3, E-selectin, and vascular endothelial growth factor (VEGF). Treatment with simvastatin resulted in a significant reduction in the frequency of pain (P = 0·0003), oral analgesic use (P = 0·003) and circulating hs-CRP (P = 0·003), soluble (s)E-selectin (P = 0·01), sICAM-1 (P = 0·02), sICAM-3 (P = 0·02) and sVEGF (P = 0·01). Simvastatin had no effect on pain intensity or levels of NOx, sP-selectin and sVCAM-1. The observed reductions in pain rate and markers of inflammation were greatest in subjects receiving hydroxycarbamide (HC), suggesting a synergistic effect of simvastatin. These results provide preliminary clinical data to support a larger trial of simvastatin in SCA. Summary Sickle cell anaemia (SCA) is a progressive vascular disease characterized by episodic vaso‐occlusive pain. Despite the broad impact of inflammation on acute and chronic clinical manifestations of SCA, no directed anti‐inflammatory therapies currently exist. Statins are cholesterol‐lowering agents shown to confer protection from vascular injury by suppressing inflammation. We previously documented a reduction in soluble biomarkers of inflammation in patients with sickle cell disease treated with simvastatin. To determine the potential clinical efficacy of simvastatin, we treated 19 SCA patients with single daily dose simvastatin for 3 months and assessed changes from baseline in the frequency and intensity of diary‐reported pain and levels of circulating nitric oxide metabolites (NOx), high sensitivity C‐reactive protein (hs‐CRP), vascular cell adhesion molecule 1 (VCAM‐1), intercellular adhesion molecule 1 (ICAM‐1), ICAM‐3, E‐selectin, and vascular endothelial growth factor (VEGF). Treatment with simvastatin resulted in a significant reduction in the frequency of pain (P = 0·0003), oral analgesic use (P = 0·003) and circulating hs‐CRP (P = 0·003), soluble (s)E‐selectin (P = 0·01), sICAM‐1 (P = 0·02), sICAM‐3 (P = 0·02) and sVEGF (P = 0·01). Simvastatin had no effect on pain intensity or levels of NOx, sP‐selectin and sVCAM‐1. The observed reductions in pain rate and markers of inflammation were greatest in subjects receiving hydroxycarbamide (HC), suggesting a synergistic effect of simvastatin. These results provide preliminary clinical data to support a larger trial of simvastatin in SCA. Summary Sickle cell anaemia (SCA) is a progressive vascular disease characterized by episodic vaso-occlusive pain. Despite the broad impact of inflammation on acute and chronic clinical manifestations of SCA, no directed anti-inflammatory therapies currently exist. Statins are cholesterol-lowering agents shown to confer protection from vascular injury by suppressing inflammation. We previously documented a reduction in soluble biomarkers of inflammation in patients with sickle cell disease treated with simvastatin. To determine the potential clinical efficacy of simvastatin, we treated 19 SCA patients with single daily dose simvastatin for 3 months and assessed changes from baseline in the frequency and intensity of diary-reported pain and levels of circulating nitric oxide metabolites (NOx), high sensitivity C-reactive protein (hs-CRP), vascular cell adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1), ICAM-3, E-selectin, and vascular endothelial growth factor (VEGF). Treatment with simvastatin resulted in a significant reduction in the frequency of pain (P = 0·0003), oral analgesic use (P = 0·003) and circulating hs-CRP (P = 0·003), soluble (s)E-selectin (P = 0·01), sICAM-1 (P = 0·02), sICAM-3 (P = 0·02) and sVEGF (P = 0·01). Simvastatin had no effect on pain intensity or levels of NOx, sP-selectin and sVCAM-1. The observed reductions in pain rate and markers of inflammation were greatest in subjects receiving hydroxycarbamide (HC), suggesting a synergistic effect of simvastatin. These results provide preliminary clinical data to support a larger trial of simvastatin in SCA. Sickle cell anaemia (SCA) is a progressive vascular disease characterized by episodic vaso-occlusive pain. Despite the broad impact of inflammation on acute and chronic clinical manifestations of SCA, no directed anti-inflammatory therapies currently exist. Statins are cholesterol-lowering agents shown to confer protection from vascular injury by suppressing inflammation. We previously documented a reduction in soluble biomarkers of inflammation in patients with sickle cell disease treated with simvastatin. To determine the potential clinical efficacy of simvastatin, we treated 19 SCA patients with single daily dose simvastatin for 3 months and assessed changes from baseline in the frequency and intensity of diary-reported pain and levels of circulating nitric oxide metabolites (NOx), high sensitivity C-reactive protein (hs-CRP), vascular cell adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1), ICAM-3, E-selectin, and vascular endothelial growth factor (VEGF). Treatment with simvastatin resulted in a significant reduction in the frequency of pain (P = 0·0003), oral analgesic use (P = 0·003) and circulating hs-CRP (P = 0·003), soluble (s)E-selectin (P = 0·01), sICAM-1 (P = 0·02), sICAM-3 (P = 0·02) and sVEGF (P = 0·01). Simvastatin had no effect on pain intensity or levels of NOx, sP-selectin and sVCAM-1. The observed reductions in pain rate and markers of inflammation were greatest in subjects receiving hydroxycarbamide (HC), suggesting a synergistic effect of simvastatin. These results provide preliminary clinical data to support a larger trial of simvastatin in SCA. |
| Author | Kuypers, Frans Larkin, Sandra Jacob, Eufemia Vichinsky, Elliott Styles, Lori Hoppe, Carolyn |
| AuthorAffiliation | 4 Pharmacyclics, Inc, Sunnyvale, CA 3 School of Nursing, University of California Los Angeles, CA 1 Department of Hematology-Oncology, UCSF Benioff Children’s Hospital Oakland, Oakland, CA 2 Children’s Hospital Oakland Research Institute, Oakland, CA |
| AuthorAffiliation_xml | – name: 4 Pharmacyclics, Inc, Sunnyvale, CA – name: 2 Children’s Hospital Oakland Research Institute, Oakland, CA – name: 1 Department of Hematology-Oncology, UCSF Benioff Children’s Hospital Oakland, Oakland, CA – name: 3 School of Nursing, University of California Los Angeles, CA |
| Author_xml | – sequence: 1 givenname: Carolyn surname: Hoppe fullname: Hoppe, Carolyn email: choppe@mail.cho.org organization: UCSF Benioff Children's Hospital Oakland – sequence: 2 givenname: Eufemia surname: Jacob fullname: Jacob, Eufemia organization: University of California Los Angeles – sequence: 3 givenname: Lori surname: Styles fullname: Styles, Lori organization: Pharmacyclics, Inc – sequence: 4 givenname: Frans surname: Kuypers fullname: Kuypers, Frans organization: Children's Hospital Oakland Research Institute – sequence: 5 givenname: Sandra surname: Larkin fullname: Larkin, Sandra organization: Children's Hospital Oakland Research Institute – sequence: 6 givenname: Elliott surname: Vichinsky fullname: Vichinsky, Elliott organization: UCSF Benioff Children's Hospital Oakland |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28369718$$D View this record in MEDLINE/PubMed |
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Sickle cell anaemia (SCA) is a progressive vascular disease characterized by episodic vaso‐occlusive pain. Despite the broad impact of inflammation on... Sickle cell anaemia ( SCA ) is a progressive vascular disease characterized by episodic vaso‐occlusive pain. Despite the broad impact of inflammation on acute... Sickle cell anaemia (SCA) is a progressive vascular disease characterized by episodic vaso-occlusive pain. Despite the broad impact of inflammation on acute... Summary Sickle cell anaemia (SCA) is a progressive vascular disease characterized by episodic vaso-occlusive pain. Despite the broad impact of inflammation on... |
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| SubjectTerms | Adolescent Adult Analgesics Analgesics - therapeutic use Anemia Anemia, Sickle Cell - complications Arterial Occlusive Diseases - complications Biomarkers - metabolism C-reactive protein C-Reactive Protein - metabolism Cell adhesion & migration Cell adhesion molecules Child Cholesterol clinical effect E-selectin E-Selectin - metabolism Female Hematology Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Hydroxyurea Inflammation Intercellular adhesion molecule 1 Intercellular Adhesion Molecule-1 - metabolism Male Metabolites Nitric oxide Nitric Oxide - metabolism Pain Pain - prevention & control sickle cell anaemia Sickle cell anemia Sickle cell disease Simvastatin Simvastatin - therapeutic use Statins Vascular cell adhesion molecule 1 Vascular Cell Adhesion Molecule-1 - metabolism Vascular endothelial growth factor Vascular Endothelial Growth Factor A - metabolism vaso‐occlusive pain Young Adult |
| Title | Simvastatin reduces vaso‐occlusive pain in sickle cell anaemia: a pilot efficacy trial |
| URI | https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fbjh.14580 https://www.ncbi.nlm.nih.gov/pubmed/28369718 https://www.proquest.com/docview/1920449091 https://www.proquest.com/docview/1884167100 https://pubmed.ncbi.nlm.nih.gov/PMC5435522 |
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