Management Strategies for Statin-Associated Muscle Symptoms: How Useful Is Same-Statin Rechallenge?

• Published in: Canadian journal of cardiology 2017-05, Vol.33 (5), p.666-673
• Main Authors: Brennan, Emily T., MD, FRCPC, Joy, Tisha R., MD, FRCPC, FACE
• Format: Article
• Language: English
• Subjects: Aged; Canada - ethnology; Cardiovascular; Cholesterol, LDL - analysis; Cholesterol, LDL - metabolism; Drug Substitution - methods; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Hypercholesterolemia - drug therapy; Hypercholesterolemia - epidemiology; Hypercholesterolemia - metabolism; Lipid Metabolism - drug effects; Male; Medication Therapy Management; Middle Aged; Muscular Diseases - chemically induced; Muscular Diseases - diagnosis; Muscular Diseases - epidemiology; Muscular Diseases - prevention & control; No-Observed-Adverse-Effect Level; Retrospective Studies; Treatment Outcome
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2017.02.013

Abstract Background Statin-associated muscle symptoms (SAMS) are common. Rechallenge with the same statin (same-statin rechallenge) has recently been included as part of a proposed scoring index for diagnosing SAMS, but data regarding tolerability and efficacy of same-statin rechallenge, compared with other strategies, is minimal. In this study we evaluated the tolerability, percent change in low-density lipoprotein cholesterol (LDL-C), and proportion of patients achieving their LDL-C targets among 3 common management strategies—same-statin rechallenge, switching to a different statin (statin switch), and use of nonstatin medications only. Methods We performed a retrospective analysis of 118 patients referred to our tertiary care centre for management of SAMS, defined as development of muscle-related symptoms with 2 or more statins. Baseline and last follow-up lipid parameters were documented. Patients were classified as tolerant of a strategy if, at their last follow-up, they remained on that strategy. Results After a median follow-up of 17 months, most (n = 79; 67%) patients were able to tolerate a statin. Tolerability was similar among the 3 treatment strategies (71% same-statin rechallenge vs 53% statin switch vs 57% for nonstatin therapy only; P  = 0.11). Those in the same-statin rechallenge and statin switch groups achieved greater LDL-C reductions compared with those who only tolerated nonstatins (−38.8 ± 3.4% vs −36.4 ± 2.9% vs −17.3 ± 4.5%; P  = 0.0007). A greater proportion of patients in the same-statin rechallenge group achieved their target LDL-C compared with those in the nonstatin therapy only group (50% vs 15%; odds ratio, 6.8; 95% confidence interval, 1.5-40.7; P  = 0.04). Conclusions Among individuals with a history of SAMS, most will tolerate statin therapy. Same-statin rechallenge was highly tolerable and efficacious. Thus, same-statin rechallenge might warrant increased utilization.