Journal article
Statin-Associated Autoimmune Myopathy: A Systematic Review of 100 Cases
Journal of clinical rheumatology, v 23(3), pp 149-154
01 Apr 2017
PMID: 28277343
Abstract
Background Statins are a group of drugs that reduce the levels of triglycerides and cholesterol in blood by inhibiting HMG-CoA reductase, an enzyme involved in rate limiting step in cholesterol synthesis. About 2-20% patients on statins develop toxic myopathies, which usually resolve on discontinuation of statin. More recently, an immune-mediated necrotizing myopathy has been found to be associated with statin use which in most cases requires treatment with immunosuppressants.
Objective To perform a systematic review on published case reports and case series of statin-associated autoimmune myopathy.
Methods A comprehensive search of PUBMED, EMBASE, Cochrane library and ClinicalTrials.gov databases was performed for relevant articles from inception until March 19, 2016 to identify cases of statin-associated necrotizing myopathy and characterize their symptoms, evaluation and response to treatment.
Results A total of 16 articles describing 100 patients with statin-associated autoimmune myopathy were identified. The mean age of presentation was 64.72 years, and 54.44% were males. The main presenting clinical feature was proximal muscle weakness, which was symmetric in 83.33% of patients. The mean creatine kinase (CK) was 6853 IU/l. Anti-HMG-CoA reductase antibody was positive in all cases tested (n = 57/57, 100%). In patients with no anti-HMG-CoA antibody results, diagnosis was established by findings of necrotizing myopathy on biopsy. Among the 83 cases where muscle biopsy information was available, 81.48% had necrosis, while 18.51% had combination of necrosis and inflammation. Most (83.82%) patients received two or more immunosuppressants to induce remission. Ninety-one percent had resolution of symptoms after treatment.
Conclusion Statin-associated necrotizing myopathy is a symmetric proximal muscle weakness associated with extreme elevations of CK. It is common in males and can occur after months of statin use. It is associated with necrosis on muscle biopsy and the presence of anti-HMG-CoA reductase antibodies. It usually requires discontinuation and immune suppression for resolution. Rechallenge with statin is unsuccessful in most cases.
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Details
- Title
- Statin-Associated Autoimmune Myopathy: A Systematic Review of 100 Cases
- Creators
- Salik Nazir - Thomas Jefferson UniversitySaroj Lohani - Thomas Jefferson UniversityNiranjan Tachamo - Thomas Jefferson UniversityDilliram Poudel - Reading Hlth Syst, 6th Ave & Spruce St, Wyomissing, PA 19611 USAAnthony Donato - Thomas Jefferson University
- Publication Details
- Journal of clinical rheumatology, v 23(3), pp 149-154
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Medicine (Graduate); General Internal Medicine
- Web of Science ID
- WOS:000398801500004
- Scopus ID
- 2-s2.0-85014598543
- Other Identifier
- 991022161739204721