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Immune‐mediated necrotizing myopathy associated with statins
Author(s) -
GrableEsposito Phyllis,
Katzberg Hans D.,
Greenberg Steven A.,
Srinivasan Jayashri,
Katz Jonathan,
Amato Anthony A.
Publication year - 2010
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/mus.21486
Subject(s) - polymyositis , medicine , discontinuation , dermatomyositis , myopathy , inflammatory myopathy , myositis , inclusion body myositis , muscle biopsy , muscle weakness , statin , gastroenterology , weakness , myalgia , creatine kinase , etiology , surgery , biopsy
We report patients from two neuromuscular centers who were evaluated between the years 2000 and 2008 and met the following criteria: (1) proximal muscle weakness occurring during or after treatment with statins; (2) elevated serum creatine kinase (CK); (3) persistence of weakness and elevated CK despite discontinuation of the statin; (4) improvement with immunosuppressive agents; and (5) muscle biopsy showing necrotizing myopathy without significant inflammation. Twenty‐five patients fulfilled our inclusion criteria. Twenty‐four patients required multiple immunosuppressive agents. Fifteen patients relapsed after being tapered off immunosuppressive therapy. Exposure to statins prior to onset was significantly higher in patients with necrotizing myopathy (82%) as compared to those with dermatomyositis (18%), polymyositis (24%), and inclusion‐body myositis (38%) seen in the same time period. The lack of improvement following discontinuation of statins, the need for immunosuppressive therapy, and frequent relapse when treatment was tapered suggest an immune‐mediated etiology for this rare, statin‐associated necrotizing myopathy. Muscle Nerve, 2010