Corticosteroids plus statins in patients with primary immune thrombocytopenia and hyperlipidemia: A multicenter retrospective cohort study.

BACKGROUND: Hyperlipidemia is prevalent in primary immune thrombocytopenia (ITP) and may exacerbate bleeding severity and compromise treatment responses. Statins possess lipid-lowering and anti-inflammatory properties, but their influence on corticosteroid therapy in ITP patients with hyperlipidemia remains unclear. OBJECTIVES: This study aimed to compare the efficacy and safety of initial corticosteroid therapy between patients with or without concomitant statin use for pre-existing hyperlipidemia in a cohort of newly diagnosed ITP patients. DESIGN: A multicenter retrospective propensity score-matched study. METHODS: Newly diagnosed ITP patients with pre-existing hyperlipidemia from 9 medical centers were analyzed. Patients were divided into 2 groups based on statin use (statin vs. non-statin). Propensity score matching (PSM) was employed to balance baseline characteristics. Treatment outcomes, including response rates, duration of response (DOR), and safety, were compared. RESULTS: After PSM, 104 patients (52 per group) were included. Baseline characteristics were comparable. Initial response rates were similar between the statin and non-statin groups (67.3% vs. 65.4%, P = 0.836), with the 95% confidence interval (CI) for the between-group risk difference ranging from -15.83% to 19.51%. The median time to response was numerically shorter in the statin group, although this difference did not reach statistical significance (4 [2-8] days vs. 5 [2-12] days, P = 0.054). Notably, the sustained response (SR) rate at 6 months was significantly higher in the statin group compared to the non-statin group (50.0% vs. 30.8%, P = 0.046), with the 95% CI for the between-group risk difference ranging from 0.41% to 36.25%. Kaplan-Meier analysis also demonstrated a significant longer duration of response (DOR) in the statin group (P = 0.044). No serious adverse events were observed in either group during follow-up. CONCLUSION: In this retrospective, propensity score-matched cohort, concomitant statin use was associated with higher 6-month SR rates and longer DOR in newly diagnosed ITP patients with pre-existing hyperlipidemia, without an apparent increase in serious adverse events. These observational findings warrant further validation in larger, prospective cohorts.