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June 11, 2014
Discontinuing Statins Better for Terminally Ill Patients
Chicago—At what point should terminally ill patients discontinue statins and other preventive therapies for diseases unlikely to be the cause of their death? Until now, pharmacists and other healthcare professionals didn’t have much evidence-based information to answer that question. A new study presented by Duke University researchers at the American Society of Clinical Oncology annual meeting in Chicago found that discontinuing statins at the end of life not only doesn’t harm dying patients but actually may benefit them. The study found that discontinuing statins in patients with advanced illnesses led to improved overall quality of life, lower costs, and no increased deaths. In fact, patients who stopped taking statins at the end of life appeared to live slightly longer, according to the research. “When you look at the number of medications people take when they are dying, it doubles in the last year of life,” said lead author Amy Abernethy, MD, PhD, director of the Center for Learning Health Care at the Duke Clinical Research Institute and a member of the Duke Cancer Institute. “Cancer patients, for example, take medications for pain, nausea and other problems associated with advanced disease,” Abernethy said. “Many don’t have an appetite, and simply swallowing medications can be a problem. So the issue is whether some longstanding medications such as cholesterol-lowering drugs might be safely discontinued, but there has been little research to help guide clinicians in making that recommendation.” While statins were initially chosen for research because they are so widely prescribed, the investigators said they might eventually look at hypertension and blood-thinning medications. For the study, researchers focused on 381 patients, all of whom faced the likelihood of dying within a year and had been taking statins for at least 3 months. With half randomized to continue taking the drug and the other half to discontinuing it, the patients were followed for up to a year to monitor survival, cardiovascular events and changes in quality of life. For the 192 study patients who continued statins, the median survival was 190 days compared to 229 days for the 192 participants who stopped taking the drugs. In addition, the terminal patients who discontinued the drugs reported a better overall quality of life and improved psychological well being as well as lower expenses; statins cost $716 per person over the course of the trial for name-brand drugs and $629 for generics. Based on population estimates in the United States, the researchers suggested that as much as $603 million a year could be saved if patients in the late stages of fatal illnesses were to discontinue statin therapy. “This is a decision that needs to be discussed between patients and their doctors; it’s not something that should be done independently or in a one-size-fits-all manner,” Abernethy explained. “But our study found that patients who discontinued statins reported improvements in quality of life. This runs counter to the idea that discontinuing a treatment would cause people to somehow feel as if they were getting less care or inadequate care.” “These are conversations that need to be had,” she added. “This brings us to a new era of asking how to right-size care, and how to bring evidence to that issue. There is an important message here that taking things away isn’t always bad.”
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