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**sharon sanders** · November 2, 2009, 11:31 AM

Re: Sharon Sanders Interviews David Fedson M.D. Today on America's Web Radio 4 PM EST

Statins Revisited

# 3911

The question as to whether statins ? commonly used cholesterol lowering drugs ? might play a positive role in the treatment of influenza and pneumonia is one that we?ve discussed numerous times over the years.

We?ve seen a see-sawing of opinion, driven by a parade of conflicting studies. Today we?ve new research to look at, but first a review of the recent past.

Dr. David Fedson was probably the first to champion the idea of using statins for an influenza pandemic. In his paper on the subject, published in July of 2006.

Pandemic Influenza: A Potential Role for Statins in Treatment and Prophylaxis
David S. Fedsona

The next influenza pandemic may be imminent. Because antiviral agents and vaccines will be unavailable to people in most countries, we need to determine whether other agents could offer clinical benefits. Influenza is associated with an increase in acute cardiovascular diseases, and influenza viruses induce proinflammatory cytokines.

Statins are cardioprotective and have anti-inflammatory and immunomodulatory effects, and they thus might benefit patients with influenza.

In 2007 we saw a study that seemed to support the idea, that indicated that statins lowered the mortality rate of people with pneumonia.

Statin drugs lower respiratory death risk: study
Tue Apr 10, 2007 12:40pm EDT
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - People who use statin drugs are less likely to die of influenza and chronic bronchitis, according to a study that shows yet another unexpected benefit of the cholesterol-lowering medications.

Their study of more than 76,000 people showed that those who had taken statins for at least 90 days had a much lower risk of dying from chronic obstructive pulmonary disease or COPD, the technical name for emphysema and chronic bronchitis.

Dr Fedson and Peter Dunnill, DSc,FREng then collaborated on a commentary, published in the Permanente Journal, Summer 2007 edition, on how we might confront an imminent pandemic.

The commentary was called New Approaches to Confronting an Imminent Influenza Pandemic, and in it the authors presented options including two possible routes to producing vaccine in quantity, and the use of statins to mitigate the effects of a cytokine storm.

(More on Dr. Fedson at the bottom of this blog)

In January of 2008, Australian researchers announced encouraging results from studies conducted on mice given gemfibrozil, a fibrate, which is another class of cholesterol lowering drug.

And just a year ago, in October of 2008, we learned:

Statins may cut pneumonia death, blood clot risks
27 Oct 2008 20:00:13 GMT
Source: Reuters
By Will Dunham
WASHINGTON, Oct 27 (Reuters) - Cholesterol-fighting drugs known as statins reduced the risk of dying from pneumonia or developing dangerous blood clots in the legs, adding to a growing list of benefits from the popular drugs, two research groups said on Monday.

Statins, the world's top-selling drugs, cut heart attack and stroke risk, and research has suggested other benefits including possibly protecting against Alzheimer's disease.

Of course, not all of the news was positive.

Just last July we heard that there were no signs of benefit among pneumonia patients (see Another Take On Statins And Pneumonia), where I reported on this story:

Statins don't lower risk of pneumonia in elderly

British Medical Journal study includes 3,000 Group Health patients

SEATTLE? Taking popular cholesterol-lowering statin drugs, such as Lipitor? (atorvastatin), does not lower the risk of pneumonia. That's the new finding from a study of more than 3,000 Group Health patients published online on June 16 in advance of the British Medical Journal's June 20 print issue.

"Prior research based on automated claims data had raised some hope?and maybe some hype?for statins as a way to prevent and treat infections including pneumonia," said Sascha Dublin, MD, PhD, a physician at Group Health and assistant investigator at Group Health Center for Health Studies. "But when we used medical records to get more detailed information about patients, our findings didn't support that approach."

Conflicting medical studies are nothing new. We see them all the time. Science is often messy and we get to the truth by fits and starts ? and that can sometimes take years.

Today we?ve news of new research on statins, presented at the annual meeting of the IDSA, the Infectious Diseases Society of America, in Philadelphia.

Maryn McKenna writing for CIDRAP brings us the details.

Statins may help patients with severe seasonal flu

Maryn McKenna Contributing Writer
Oct 29, 2009 (CIDRAP News) ? Commonly available drugs that are sold in lower-cost generic versions improve the survival of patients hospitalized for seasonal influenza, researchers reported today, raising the possibility of a widely available treatment that could be used in a severe flu pandemic if other drugs are in short supply.

The research, by the US Centers for Disease Control and Prevention (CDC) and scientists in several states, is part of a slate of new flu reports being presented this weekend at the annual meeting of the Infectious Diseases Society of America (IDSA) in Philadelphia. Also on the agenda: findings that flu vaccination of pregnant women has a protective effect on their babies both before and after birth, and news of what may be the first person-to-person transmission in the United States of H1N1 flu strains resistant to antiviral drugs.

The research presented Thursday examined the effect of the cholesterol-lowering drugs called statins on the clinical course of people who were already taking the drugs and then were hospitalized with lab-confirmed flu infections in the 2007-08 flu season. Those who were already on statins were half as likely to die, Meredith Vandermeer of the Oregon Public Health Division said during a press briefing at the state of the meeting.

The patients were identified via surveillance in 10 states conducted by the CDC?s Emerging Infections Programs; data on their lab results, prescriptions and outcome were drawn from reviews of their medical records. There were 2,800 lab-confirmed cases of flu in the surveillance results, Vandermeer said; 801 of those patients were recorded as taking statins during their hospital stay, presumably because they had been prescribed them before admission. Among the 2,800, 17 people who were on statins died, versus 64 were not on statins. Proportionally, that is 2.1% of those on statins and 3.2% of those not taking the drugs?a risk reduction of approximately half, Vandermeer said.

(Continue . . .)

Maryn?s article has additional details, plus reports on vaccine benefits in pregnant women, and the transmission of resistant H1N1 at a summer camp. Follow the link to read it in it?s entirety.

While not conclusive, this latest study offers some additional tantalizing evidence that statins might someday play a role in the treatment of influenza and pneumonia.

Further studies and controlled trials are needed, of course, before we can know for sure.

**sharon sanders** · November 2, 2009, 11:32 AM

Re: Sharon Sanders Interviews David Fedson M.D. Today on America's Web Radio 4 PM EST

Statins for influenza. Why don't we know if it works yet?

Category: Infectious disease ? Influenza treatment
Posted on: October 31, 2009 6:49 AM, by revere
Statins for influenza are in the news again, this time because of a paper given at the Annual Meeting of the Infectious Disease Society of America (IDSA). We'll get to it in a moment, but first a little background.
Statins are cholesterol lowering drugs that are taken by tens of millions of people (including me; I take 20 mg of generic simvastatin a day). The statins are a group of drugs that competitively inhibit an enzyme, 3 hydroxy 3 methylglutaryl coenzyme A reductase (HMG-CoA reductase). They are quite effective in lowering cholesterol and have an excellent safety profile (not perfect, but no drug is perfect except the ones that don't do anything, and even then a placebo effect can give an adverse reaction). But these drugs also seem to do a lot of other things beside lower cholesterol, some of which seem to modify the way your immune system works. That's why they are also referred to as immunomodulators. One immune system effect seems to prevent activation of a transcription factor (a signal to your DNA to make specific proteins) called NF-kappaB. Somehow this produces an anti-inflammatory effect.
Some severe cases of influenza are complicated by an immune dysregulation (sometimes called a cytokine storm) characterized by runaway production of inflammation-associated chemicals in the lung and other organs. Hence the thought that an immunomodulator might be of use. We first posted on the suggestion that statins might be helpful in this way as far back as 2005 when we were still on our old site at Blogger.com (remember, you heard it here first):

In an extremely interesting article in the Clinicians Biosecurity Network Weekly Bulletin (issue of 9/27/05) Borio and Bartlett review a suggestion of David Fedson, an expert on vaccines (and former Director of Medical Affairs at Aventis Pasteur), that statins (tradenames Zocor or Lipitor) might be helpful in preventing serious complications of influenza, perhaps by dampening the cytokine response. [snip]
The idea that statins might be helpful for sepsis or influenza is based on more than speculation about mechanism. In 2004 Almog et al. (Circulation, Aug 17 2004;110(7):880-885) reported that patients admitted to the hospital with acute bacterial infections and who were on statins for more than a month for other reasons had a dramatically reduced incidence of severe sepsis (19% versus 2.2%) and reduced admission to the Intensive Care Unit (12.2% vs. 3.7%). [NB: sepsis is a similar immune dysregulation to the one caused by influenza.] An interesting point is that patients on statins might be expected to be at greater risk because they are taking a medication for a pre-existing medical condition.
Another study (.pdf available free on line here) looked back at the experience of over 700 patients that were admitted to a hospital for pneumonia. About 100 of them were also taking statins. Using 30-day mortality as a measure of outcome, the statin group had about two thirds fewer deaths than the non-statin group (odds ratio .36, 95% confidence interval .14 - .92). (Effect Measure, September 29, 2005)

At the time it was too early to say anything with confidence, but we were puzzled why Dave Fedson's (prescient) suggestion wasn't being followed up. He continued to urge deeper study and published a review of the relevant literature (abstract here). When a study was published in Nature showing that the 1918 pandemic virus caused a sepsis-like immune dysregulation in mouse studies (our post here), Fedson wrote a frustrated letter to the The Times of London, begging for urgent action. We quoted some of the letter in a 2007 post, "Statins for H5N1. The road not taken. Why?":

The report in Nature describing the increased host immune response caused by the 1918 pandemic influenza virus is the latest in a series of studies suggesting it is the host response (the "cytokine storm") that is probably responsible for most deaths now being seen with H5N1 [bird flu] infections. If the H5N1 virus leads to the next human pandemic, and if the situation is similar to that in 1918, there could be 350 million deaths worldwide. Conventional vaccines will be too little too late, and limited supplies of antiviral medications will be available in only a few countries. However, we have recently learnt that statins (the drugs used to treat high cholesterol) decrease mortality due to pneumonia by 40-60 per cent, suggesting that, by modifying the influenza "cytokine storm", statins could be life-saving.
The scientific rationale for considering statins for pandemic use is persuasive, but the public health rationale is hugely compelling. Unlike vaccines and antivirals, generic statins are available in almost all countries, and treating an individual patient would probably cost less than ?1. The pandemic might be imminent, yet nothing is being done by scientists and health officials to explore this idea. Why? (Letter from David Fedson to The Times [of London], October 4, 2006)

At the time (2006) we thought Dave Fedson asked a good question. Why was there no apparent action?
In 2007 we again raised the statin issue in connection with another study showing statin's protective effect in chronic obstructive pulmonary disease (COPD), pneumonia and influenza in 76,000 patients from a health maintenance organization who took statins for at least 90 days. Deaths from COPD were cut dramatically and cut significantly for pneumonia and influenza. Later that year we wondered again (in a post about new antivirals) why statins weren't on the research agenda?

While we are talking about new drugs, however, it is somewhat disappointing not to see more information on the utility of a class of old drugs, the statins. Statins are cheap, plentiful and have a fairly good safety profile. The statins are used for their cholesterol lowering feature but seem to have other effects as well. Now a paper on another cholesterol lowering drug, gemfibrozil, is also showing an ability to protect against the lethal effects of influenza infection (Budd et al., Antimicrob Agents Chemother. 2007 Jun 11). Survival against H2N2 in mice increased from 26% to 52% after an intraperitoneal injection of gemfibrozil 4 to 10 days after intranasal inoculation with the virus. Maybe we should be looking at the cholesterol connection a little closer?
The new drugs under development will have to go through an intense process of safety and efficacy testing. Meanwhile we also have drugs like the statins and gemfibrozil that are available and approved and could be brought into service immediately in the event of a pandemic. No big bucks here. These are drugs off patent and not hugely profitable.
But wouldn't it be useful to be investigating their utility a little more avidly? Or am I missing something? (Effect Measure, June 21, 2007)

Then earlier this year we revisited the science in a long post, "More on the science of the influenza 'cytokine storm'." There we tried to explain the science behind an important paper in the Proceedings of the National Academy of Sciences with the unintriguing title, "TNF/iNOS-producing dendritic cells are the necessary evil of lethal influenza virus infection" (Aldridge et al., PNAS). It was Dave Fedson that tipped me off to the paper over a long lunch. The paper suggested a role for a class of drugs called peroxisome proliferator activated receptor (PPAR) agonists, one of which is the diabetes drug, Avandia. Our take:

Before you run out and buy Avandia, you should know that there are some significant questions about risk of heart attack for those taking it long term for diabetes. On the other hand, balancing that risk against death from a pandemic flu virus suggests it is worthwhile to consider as part of our arsenal should a pandemic develop. Unfortunately, I fear it will be put on the shelf with other possibly effective and low cost approaches, like statins. Antivirals and vaccines seem to be the only weapons that the infectious disease folks can imagine. (Effect Measure, April 3, 2009)

These are not the only places where the statin-influenza connection came up at Effect Measure (here's another). We mention them because this has been on the scientific radar screen for at least 5 years. This week we did get some more information from the IDSA meetings. There is no paper, only press accounts (here, here, here, here) and Mike Coston at Avian Flu Diary also has a good account where he also reviews his previous posts (Mike is one of the best in flublogia; if you are interested in flu and don't read his blog, you should). I looked at the abstract for the paper and it reports different numbers than the press accounts, so I'm not sure which numbers are correct, although the bottom line is the same: people who were using statins for their cholesterol when they were admitted to the hospital for swine flu had lesser odds of dying than those who didn't:

[Lead author Meredith] Vandermeer and colleagues scrutinised medical records of 2,800 people who were hospitalised with seasonal flu in 10 states during the 2007-2008 influenza season. In that group of patients, 17 of 801 who were on statins in the hospital (~2.1%) died of influenza or its complications. Of the 1,999 who were not on statins in the hospital, 64 died (~3.2%). Vandermeer said that represented a 54% decreased risk, taking into account other risk factors such as age and use of antiviral drugs.
She said that the database did not allow the researchers to determine the dose of statin that patients were on nor how long the patients had been taking the cholesterol-lowering drugs. She said that the researchers are analysing the data to determine if one brand of statin is associated with better odds of surviving the flu than another.
"We believe that statins may be able to mediate an immune response in addition to being able to lower cholesterol," she said. However, Vandermeer said the results of the study would not be sufficient to makes recommendations for prescribing statins for treatment of infectious diseases. (Ed Sussman, Doctor's Guide)

The two groups (statin users and non-statin users) were not exactly alike with respect to other risk factors that might affect survival, so it wasn't sufficient to compare 2.1% with 3.2%. The statin users were more likely to be older, male and White or Asian. As the use of statins would suggest, they were also more likely to have an underlying health condition like heart disease and to have been vaccinated against flu last season. Some of these differences would tend to increase the mortality of statin users, others to decrease it. To account for the differences the researchers employed a standard statistical technique called multiple logistic regression, which produced the 54% decreased risk number in the press reports (the decrease in odds in the abstract is 66%).
So have we finally taken the statin road? The study was done by scientists from a number of state health departments, universities and CDC. That sounds like some kind of buy-in. How much, we don't know yet. But a post on the IDSA paper at Nature's blog, The Great Beyond, suggests that it isn't exactly pedal to the metal:

While researchers are calling for studies to evaluate the effectiveness of the cholesterol lowering drugs known as statins for reducing influenza-associated deaths, one such study is just getting underway, largely on volunteerism and shoestring funding. [snip]
At a press teleconference, VanderMeer suggested that double-blind, placebo-controlled studies be carried out in a hospital setting. I haven't seen anyone report that one such study has already begun. Gordon Bernard at Vanderbilt University is studying the effects of rosuvastatin (Crestor) in patients hospitalized with the flu. It?s a randomized, double-blind, placebo-controlled study and the researchers recruited their first patient this week, Bernard told Nature.
Finding the funding for such a study has been difficult. But, Bernard realized that the current H1N1 pandemic presents an unprecedented opportunity to study this intervention. ?We?ve never seen this kind of thing happen with so many patients with severe symptom,.? he says.

In August, he and his collaborators decided to begin working on a volunteer basis to get the study underway, including getting all the necessary approvals. Astra Zeneca, which manufactures Crestor, agreed to provide medication and placebo, but would not fund that the study. ?We?re still working as a volunteer group and continuing to put feelers out in every way we can,? Bernard says.

As for the positive press for statins, Bernard calls it something of a double-edged sword. ?It lends credence to the idea that we should have a randomized trial,? he says, but ?It also makes it difficult at the bedside.? As patients hear more about statins possibly being effective, it can complicate recruitment into placebo-controlled studies, he says. (Brendan Maher with contributions by Declan Butler, The Great Beyond)

Hmmm. On the statin road, perhaps, but not full speed ahead. Why not?

**sharon sanders** · November 2, 2009, 11:40 AM

Re: Sharon Sanders Interviews David Fedson M.D. Today on America's Web Radio 4 PM EST

Yes - Why Not?? After 6 years from the start of Dr. Fedson's effort?? After 3 years on FT??

Why Not??

http://www.youtube.com/watch?v=Wos-dDxpJlQ

Give us the truth.

Give us the tools.

Give us the power to control our own lives.

And in the process - save many of the 6+ billion people in the world who will never see vaccine for pandemic influenza.

**sharon sanders** · November 2, 2009, 02:58 PM

Re: Sharon Sanders Interviews David Fedson M.D. Today on America's Web Radio 4 PM EST

hat tip Resident DavidFedson -

Statins for the Prevention and Treatment of Infections

A Systematic Review and Meta-analysis

Imad M. Tleyjeh, MD, MSc; Tarek Kashour, MD; Fayaz A. Hakim, MD; Valerie A. Zimmerman, PhD; Patricia J. Erwin, MLS; Alex J. Sutton, PhD; Talal Ibrahim, MBBS(Hons), MD, FRCS(Tr&Orth)

Arch Intern Med. 2009;169(18):1658-1667.

  Background Emerging epidemiological evidence suggests that statin use may reduce the risk of infections and infection-related complications. Our objective was to examine the association between statin use and the risk of infections and related outcomes.

 
Methods We searched several electronic databases from inception through December 2007 for randomized trials and cohort studies that examined the association between statin use and the risk or outcome of infections. Data on study characteristics, measurement of statin use, outcomes (adjusted for potential confounders), and quality assessment were extracted.

 
Results Sixteen cohorts were eligible and differed in representativeness, outcome assessment, and comparability of exposed (statin) and unexposed (nonstatin) groups. Nine cohorts addressed the role of statins in treating infections: bacteremia (n = 3), pneumonia (n = 3), sepsis (n = 2), and bacterial infection (n = 1). The pooled adjusted effect estimate was 0.55 (95% confidence interval, 0.36-0.83; I2 = 76.5%) in favor of statins. Seven cohorts addressed infection prevention in patients with vascular diseases (n = 3), chronic kidney disease (n = 1), diabetes (n = 1), intensive care unit?acquired infections (n = 1), and in general practice (n = 1). The pooled effect estimate was 0.57 (95% confidence interval, 0.43-0.75; I2 = 82%) in favor of statin use; there was some evidence of publication bias for this analysis (Egger test; P = .07). Meta-regression did not identify potential effect modifiers that explain the between-study heterogeneity.

 
Conclusions Results for our meta-analysis suggest that statin use may be associated with a beneficial effect in treating and preventing different infections. Given the presence of heterogeneity and publication bias, there is a need for randomized trials to confirm the benefit of statin use in this context.

Please - someone - fund trials.........

http://www.youtube.com/watch?v=xlkDK3c86jU

**AlaskaDenise** · November 2, 2009, 04:58 PM

Re: Sharon Sanders Interviews David Fedson M.D. Today on America's Web Radio 4 PM EST

I was interested to hear Dr. Fedson discuss the implications of insulin resistance for influenza patients. We had discussed it some here. Given that a high number of people suffering (often undiagnosed) from this condition, it seems this is a teachable moment as people are searching for influenza treatments.

I have a question:

If a person went on the simple diet to reverse insulin resistance (limited carbs/meal, frequent small meals, exercise), could the IR situation be reversed quickly enough to create an effective increase in resistance to H1N1?

.

**Snowy Owl** · November 2, 2009, 05:05 PM

Re: Sharon Sanders Interviews David Fedson M.D. Today on America's Web Radio 4 PM EST

Thank You Sharon and Dr Fedson for talking as it is in ICU, in Public Health Management.

This is a call for tired Work Horses, to get the Second Wind and get that Wagon out of the mud and carry it to the villages and towns.

**AlaskaDenise** · November 2, 2009, 05:11 PM

Re: Sharon Sanders Interviews David Fedson M.D. Today on America's Web Radio 4 PM EST

This is the first time I've heard a Dr. Fedson interview.

I'm really impressed by his cross-discipline approach and obvious humanitarian concerns.

.

**sharon sanders** · November 2, 2009, 07:51 PM

Re: Sharon Sanders Interviews David Fedson M.D. Today on America's Web Radio 4 PM EST

Dr. Fedson was great as usual. Again, I am not trained professionally in media applications and I am lucky that these guests will grant interviews.

I hope that some entity funds this study -

"..Gordon Bernard at Vanderbilt University is studying the effects of rosuvastatin (Crestor) in patients hospitalized with the flu. It’s a randomized, double-blind, placebo-controlled study and the researchers recruited their first patient this week, Bernard told Nature.

Finding the funding for such a study has been difficult. But, Bernard realized that the current H1N1 pandemic presents an unprecedented opportunity to study this intervention. “We’ve never seen this kind of thing happen with so many patients with severe symptom,.” he says...

In August, he and his collaborators decided to begin working on a volunteer basis to get the study underway, including getting all the necessary approvals. Astra Zeneca, which manufactures Crestor, agreed to provide medication and placebo, but would not fund that the study. “We’re still working as a volunteer group and continuing to put feelers out in every way we can,” Bernard says......."

Please someone - fund this.

http://www.youtube.com/watch?v=BdQ7LBo_t-Q

**tropical** · November 3, 2009, 06:38 AM

Re: Sharon Sanders Interviews David Fedson M.D. Today on America's Web Radio 4 PM EST

Thank you for the infos Dr. Fedson and Florida1.

#5:
"The pooled adjusted effect estimate was 0.55 (95% confidence interval, 0.36-0.83; I2 = 76.5%) in favor of statins."

0.55 in favor of statins

I presume: in a scale of 1 -> 55% in favor

**sharon sanders** · November 3, 2009, 07:15 AM

Re: Sharon Sanders Interviews David Fedson M.D. Today on America's Web Radio 4 PM EST

The abstract of the paper presented at IDSA:

hat tip Thornton -

Abstract 706 Control 2009‐AB‐1177‐IDSA
Session Type:
Oral Abstract Session
Session
070
Session Title:
Influenza
Location:
107‐AB
Session Time:
Friday, October 30, 2009, 2:00 pm ‐ 4:00 pm

Publishing

Role of Statins in Preventing Death among Patients Hospitalized with Lab‐confirmed Influenza Infections

http://docs.google.com/gview?a=v&q=cache:z39Fo4LVUFYJ:omk.pcipr.com/files/1084/706.pdf+IDSA+2009%3B+Abstract+706.&hl=en&gl=us&sig =AFQjCNHGcM0C0DJM-RooadWM9L8pQYKm6Q

"...administration of statins during hospitalization was significantly protective..."

Dr. William Schaffner is one of the authors. I have interviewed him in the past and he has agreed to be interviewed sometime this month.

Please - someone fund the study at Vanderbilt. The cost would be about 9 million USD.

please.......

http://www.youtube.com/watch?v=hGr8as7pPBE

**Snowy Owl** · November 3, 2009, 07:21 AM

Re: Sharon Sanders Interviews David Fedson M.D. Today on America's Web Radio 4 PM EST

Death Risks Reduced for Patients on Statins Hospitalised With Influenza: Presented at IDSA

By Ed Susman

PHILADELPHIA -- October 30, 2009 -- Patients on statin therapy who are hospitalised with seasonal influenza have about a 50% reduced risk of dying from the viral infection, researchers stated here at the 47th Annual Meeting of the Infectious Diseases Society of America (IDSA).

"This early research suggests a potential role for statins in treatment of influenza and should be studied further," said Meredith Vandermeer, Emerging Infections Program, Oregon Public Health Division, Portland, Oregon, at a press briefing here October 29.

"This is the first study that looks at the relationship between statins and death among patients hospitalised with influenza," she said.

Vandermeer and colleagues scrutinised medical records of 2,800 people who were hospitalised with seasonal flu in 10 states during the 2007-2008 influenza season.

In that group of patients, 17 of 801 who were on statins in the hospital (~2.1%) died of influenza or its complications. Of the 1,999 who were not on statins in the hospital, 64 died (~3.2%). Vandermeer said that represented a 54% decreased risk, taking into account other risk factors such as age and use of antiviral drugs.

She said that the database did not allow the researchers to determine the dose of statin that patients were on nor how long the patients had been taking the cholesterol-lowering drugs. She said that the researchers are analysing the data to determine if one brand of statin is associated with better odds of surviving the flu than another.

"We believe that statins may be able to mediate an immune response in addition to being able to lower cholesterol," she said. However, Vandermeer said the results of the study would not be sufficient to makes recommendations for prescribing statins for treatment of infectious diseases.

"It appears that statins give people some benefit," said Andrew Pavia, MD, Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah, who moderated the press briefing for the IDSA.

[Presentation title: Publishing Title: Role of Statins in Preventing Death Among Patients Hospitalized With Lab Confirmed Influenza Infections. Abstract 706]

Just a moment...

http://www.docguide.com/news/content.nsf/news/852576140048867A8525765F006192E8

**AlaskaDenise** · November 5, 2009, 05:01 AM

Sharon Sanders Interviews David Fedson M.D. Today on America's Web Radio 4 PM EST

Statins could stymie H1N1
By MARILYNN MARCHIONE
Associated Press
Updated: 11/05/2009 01:39:52 AM PST

A new treatment for swine flu may already be on pharmacy shelves — cholesterol-lowering statin drugs such as Lipitor and Zocor.

A large study found that people who were taking the drugs when they caught seasonal flu and had to be hospitalized were twice as likely to survive than those who were not on such medicines.

This doesn't prove that statins can cure flu, or that starting on them after catching the flu would help. A federal study is under way now to test that. Doctors are optimistic, because previous studies found statins may improve survival from infectious diseases.

"It's very promising," said the new study's leader, Dr. Ann Thomas of the Oregon Public Health Division. Results were discussed Oct. 29 at an Infectious Diseases Society of America conference in Philadelphia.

"It's intriguing and exciting," and the benefit seen from statins is "substantial," said Dr. William Schaffner, a Vanderbilt University doctor whose hospital in Nashville, Tenn., was involved in the research.

"There are relatively few downsides to trying statins," which are cheap, relatively safe, and already among the most widely used medicines in the world, he said.

Treatment is a crucial issue for swine flu because vaccine is slow to reach the public, and flu medicines such as Tamiflu are being reserved for only the sickest patients.

Statins have long been known to reduce inflammation along with cholesterol. Much of the damage that flu causes, whether it's seasonal or the new H1N1 virus, is from inflammation and an overreaction by the immune system as it fights the virus.

Earlier studies found that statins improved survival from pneumonia and serious bacterial bloodstream infections. The new research, sponsored by the federal Centers for Disease Control and Prevention, is the first large one in the United States to look at statins for flu.

It involved 2,800 people hospitalized with lab-confirmed seasonal flu in 10 states in 2007-2008. Medical records show that 801 received statins in the hospital. They probably were just continuing the cholesterol treatment they had been taking before catching the flu, though researchers don't know this for sure.

More than 3 percent of those not taking statins died in the hospital or the next month. The rate was half that among statin users, even though they were more likely to have underlying health problems such as heart disease. Researchers took other factors such as age into account and still saw the same benefit from statin use.

"It's an important study," said Dr. Andrew Pavia, a pediatrics professor at the University of Utah and head of the infectious disease society's pandemic flu task force. He said he now places a high priority on testing statins as a treatment.

"It gives us a pretty cost-effective tool if it works," he said.

There might be justification for trying the drugs in certain patients not doing well on any other treatment, said Dr. Ronald Turner of the University of Virginia, a prominent virologist who had no role in the new study.

"If you get yourself to the point where you don't have anything to offer and things are going poorly for the patient, then maybe to try something on a speculative note is appropriate," he said.

The statin study is the second piece of good news on the treatment front in a week. Friday, the federal Food and Drug Administration authorized emergency use of the experimental drug peramivir as a swine flu treatment.

Recent results from an Asian study showed that a single intravenous dose of peramivir (purr-AM-uh-veer) cleared up flu symptoms as effectively as five days of Tamiflu pills. Some very sick patients need IV treatments because they can't swallow pills or absorb the medicine well.

BioCryst Pharmaceuticals Inc. of Birmingham, Ala., is developing peramivir with Japan-based Shionogi & Co.

Page not found – Monterey Herald

http://www.montereyherald.com/health/ci_13719143?nclick_check=1

**gsgs** · November 5, 2009, 07:06 AM

Re: Sharon Sanders Interviews David Fedson M.D. Today on America's Web Radio 4 PM EST

> twice as likely to survive

makes well over 100% probability to survive then ;-)

are statins only rcommended for severe cases or also
for normal flu ?

**sharon sanders** · November 5, 2009, 07:26 AM

Re: Sharon Sanders Interviews David Fedson M.D. Today on America's Web Radio 4 PM EST

Statins could be effective against seasonal flu and many other diseases too:

Statins for the Prevention and Treatment of InfectionsA Systematic Review and Meta-analysis
Imad M. Tleyjeh, MD, MSc; Tarek Kashour, MD; Fayaz A. Hakim, MD; Valerie A. Zimmerman, PhD; Patricia J. Erwin, MLS; Alex J. Sutton, PhD; Talal Ibrahim, MBBS(Hons), MD, FRCS(Tr&Orth)

Arch Intern Med. 2009;169(18):1658-1667.

Results Sixteen cohorts were eligible and differed in representativeness, outcome assessment, and comparability of exposed (statin) and unexposed (nonstatin) groups. Nine cohorts addressed the role of statins in treating infections: bacteremia (n = 3), pneumonia (n = 3), sepsis (n = 2), and bacterial infection (n = 1). The pooled adjusted effect estimate was 0.55 (95% confidence interval, 0.36-0.83; I2 = 76.5%) in favor of statins. Seven cohorts addressed infection prevention in patients with vascular diseases (n = 3), chronic kidney disease (n = 1), diabetes (n = 1), intensive care unit?acquired infections (n = 1), and in general practice (n = 1). The pooled effect estimate was 0.57 (95% confidence interval, 0.43-0.75; I2 = 82%) in favor of statin use; there was some evidence of publication bias for this analysis (Egger test; P = .07). Meta-regression did not identify potential effect modifiers that explain the between-study heterogeneity.

http://archinte.ama-assn.org/cgi/content/short/169/18/1658

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