March 24, 2015 Leave a comment
The Palliative Care Research Cooperative‘s RCT of statin discontinuation came out in JAMA Internal Medicine yesterday. The patient population had a variety of terminal illnesses with an expected life span of greater than 1, but less than 12 months. Highlights of findings:
- No survival difference
- Quality of life was better on some measures, and no different on others
- Modest cost savings were realized by stopping a statin ($3.37/day; mean savings observed in trial $716)
The main story is that stopping statins in terminally ill patients can be done safely, and that doing so makes the lives of very ill people a little better, while costing a little less. Imagine how rich we would be if the RCT reported had been of a new drug that produced the same results. People would be desperate to take it!
The study was a bit different than most RCTs because it was not double blind (all persons consented to being randomized to stopping or continuing their statin; those that were in the ‘stopped’ arm knew that they had stopped taking the medicine). This was important because a key worry was whether stopping a statin would lead to a loss of hope, or other negative psychological outcomes for patients. We did not find this to be the case, but it is an important question with respect to patient well being that could not be answered via a double blind RCT. Several top medical journals wouldn’t even review the manuscript because of this issue. I would never say a journal “has to”publish a given paper, but not reviewing this paper for that reason shows they don’t get palliative care, and the very important intervention of knowing when to stop doing something.