title: Immune-mediated necrotizing myopathy associated with statins.
abstract: 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.
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. phyllis.grableesposito@va.gov
authors.forename: Phyllis
authors.initials: P
authors.lastname: Grable-Esposito
authors.forename: Hans D
authors.initials: HD
authors.lastname: Katzberg
authors.forename: Steven A
authors.initials: SA
authors.lastname: Greenberg
authors.forename: Jayashri
authors.initials: J
authors.lastname: Srinivasan
authors.forename: Jonathan
authors.initials: J
authors.lastname: Katz
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Amato
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D007107:Immune System / Q000502:physiology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007167:Immunotherapy; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000473:pathology / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000473:pathology* / Q000503:physiopathology; D009135:Muscular Diseases / Q000139:chemically induced* / Q000188:drug therapy / Q000276:immunology*; D009336:Necrosis; D012189:Retrospective Studies; D028761:Withholding Treatment
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007166:Immunosuppressive Agents; D003402:Creatine Kinase