Statin therapy in systemic lupus erythematosus: a meta-analysis of disease activity and inflammatory biomarkers

Objective Dyslipidaemia in systemic lupus erythematosus (SLE) contributes to pathogenesis and cardiovascular risk. The effect of statin therapy on SLE disease activity remains controversial. This meta-analysis systematically evaluates the impact of statins on SLE activity and inflammatory markers. Methods This study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A systematic literature search across multiple databases was conducted up to 13 November 2024. Study selection, data extraction and quality assessment were performed independently by two reviewers. Meta-analysis was conducted using R software, evaluating outcomes including SLE Disease Activity Index (SLEDAI), C-reactive protein (CRP), interleukin-6 (IL-6) and erythrocyte sedimentation rate (ESR). Results From 3596 identified records, 12 studies were included. Statins significantly reduced SLEDAI in controlled before-after studies (weighted mean difference (WMD)=−0.70, 95% CI −1.16 to −0.23; p=0.0037), but not in parallel controlled trials (WMD=−0.58, 95% CI −1.74 to 0.59; p=0.330; I² = 81.1%). Subgroup analysis showed a pronounced reduction in patients with a mean age <40 years (WMD=−1.60, 95% CI −1.98 to −1.22; p<0.001). Statins lowered CRP in both controlled before-after studies (standardised mean difference (SMD)=−0.38, 95% CI −0.73 to −0.03; p=0.032) and parallel controlled trials (SMD=−1.45, 95% CI −2.84 to −0.07; p=0.040). After excluding an outlier, the reduction in IL-6 became significant (SMD=−0.32, 95% CI −0.63 to −0.00; p=0.048). ESR was also reduced (SMD=−1.81, 95% CI −3.54 to −0.08; p=0.0406). No significant publication bias was detected. Conclusion Statin therapy may reduce disease activity and inflammation in SLE, with a consistent benefit observed in patients with a mean age <40 years. Significant heterogeneity underscores the need for future rigorously designed, age-stratified randomised trials to confirm these findings and define the target patient population. PROSPERO registration number CRD42025630267