Statin Exposure and Survival Outcomes in Amyotrophic Lateral Sclerosis in an Asian Cohort

INTRODUCTION: Data from Asian cohorts on whether statin therapy affects amyotrophic lateral sclerosis (ALS) progression are limited. We examined whether statin exposure was associated with ALS disease duration or tracheostomy-free survival in a multiethnic Asian ALS cohort. METHODS: Data from patients diagnosed with ALS between 2012 and 2025 were retrospectively reviewed. Patients were categorized as "ever" or "never" statin users for primary analyses, and as "never," "former," or "current" users at diagnosis for additional analyses. Disease duration was defined as time from symptom onset to death, and tracheostomy-free survival as time from symptom onset to tracheostomy or death without tracheostomy. Kaplan-Meier and Cox regression analyses evaluated associations between statin exposure and both outcomes. Additional analyses examined statin discontinuation after diagnosis using time-varying exposures. Sensitivity analyses excluded post-diagnosis imitators and applied 30-, 90-, and 180-day lags. RESULTS: Among 103 ALS patients, 27 (26.2%) had ever received statins. Statin exposure was not significantly associated with disease duration (hazard ratio [HR]: 1.42, 95% CI: 0.64-3.14, p = 0.387) or tracheostomy-free survival (HR: 1.04, 95% CI: 0.50-2.18, p = 0.913). Post-diagnosis statin discontinuation was associated with shorter survival in a time-varying analysis (HR: 6.52, 95% CI: 1.48-28.74, p = 0.013), although this finding was hypothesis-generating. Sensitivity analyses did not show statistically significant associations. DISCUSSION: In this multiethnic Asian ALS cohort, statin exposure was not significantly associated with disease duration or tracheostomy-free survival. These findings add to the evidence that statins do not need to be discontinued due to ALS diagnosis. Larger studies are needed to define this association.