Immune-mediated necrotizing myopathy associated with statins

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 des...

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Bibliographic Details
Published in:Muscle & nerve 2010-02, Vol.41 (2), p.185-190
Main Authors: Grable-Esposito, Phyllis, Katzberg, Hans D., Greenberg, Steven A., Srinivasan, Jayashri, Katz, Jonathan, Amato, Anthony A.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
autoimmune
Biological and medical sciences
Biopsy
Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction
Creatine Kinase - blood
Diseases of striated muscles. Neuromuscular diseases
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects
Immune System - physiology
Immunosuppressive Agents - therapeutic use
Immunotherapy
Male
Medical sciences
Middle Aged
Muscle Weakness - pathology
Muscle Weakness - physiopathology
Muscle, Skeletal - pathology
Muscle, Skeletal - physiopathology
Muscular Diseases - chemically induced
Muscular Diseases - drug therapy
Muscular Diseases - immunology
myopathy
Necrosis
necrotizing
Nervous system (semeiology, syndromes)
Neurology
Retrospective Studies
statin
toxicology
Withholding Treatment
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Summary: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
ISSN:0148-639X
1097-4598
DOI:10.1002/mus.21486