Rhabdomyolysis and acute kidney injury induced by the association of rosuvastatin and abiraterone: A case report and review of the literature

Introduction Abiraterone acetate is an inhibitor of androgens biosynthesis, approved as first-line treatment in castration-resistant prostate cancer and metastatic castration-sensitive prostate cancer. Abiraterone has been rarely associated with severe rhabdomyolysis, but the mechanism of muscle tox...

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Published in:Journal of oncology pharmacy practice 2021-01, Vol.27 (1), p.216-219
Main Authors: Ould-Nana, Ismail, Cillis, Marine, Gizzi, Marco, Gillion, Valentine, Hantson, Philippe, Gérard, Ludovic
Format: Article
Language:English
Subjects:
Abiraterone Acetate - adverse effects
Acetic acid
Acute Kidney Injury - chemically induced
Aged
Androgens
Case reports
Castration
Humans
Kidneys
Literature reviews
Liver
Liver-Specific Organic Anion Transporter 1 - antagonists & inhibitors
Male
Metastases
Prostate cancer
Prostatic Neoplasms, Castration-Resistant - drug therapy
Rhabdomyolysis
Rhabdomyolysis - chemically induced
Rosuvastatin Calcium - adverse effects
Toxicity
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Summary:Introduction Abiraterone acetate is an inhibitor of androgens biosynthesis, approved as first-line treatment in castration-resistant prostate cancer and metastatic castration-sensitive prostate cancer. Abiraterone has been rarely associated with severe rhabdomyolysis, but the mechanism of muscle toxicity is unknown. Case report We hereby present a case of severe rhabdomyolysis resulting in acute on chronic kidney injury following abiraterone initiation in a patient previously under rosuvastatin. Management and outcome Rhabdomyolysis was resolutive after rosuvastatin and abiraterone discontinuation, and kidney function recovered. There was no recurrence of muscle toxicity after re-initiation of abiraterone alone. Discussion Abiraterone selectively inhibits CYP17 as well as the hepatic transporter OATP1B1. OATP1B1 is an efflux transporter, whose function is to extract several drugs from the portal blood, allowing them to undergo hepatic metabolism. We hypothesize that abiraterone-induced inhibition of plasmatic uptake of rosuvastatin by OATP1B1 increased plasmatic concentration of rosuvastatin, leading to toxicity on muscle cells. We therefore suggest that the association between rosuvastatin and abiraterone should be avoided.
ISSN:1078-1552
1477-092X
DOI:10.1177/1078155220923001