Arthritis Research & Therapy (Jan 2020)
Statin-induced anti-HMGCR myopathy: successful therapeutic strategies for corticosteroid-free remission in 55 patients
- Alain Meyer,
- Yves Troyanov,
- Julie Drouin,
- Geneviève Oligny-Longpré,
- Océane Landon-Cardinal,
- Sabrina Hoa,
- Baptiste Hervier,
- Josiane Bourré-Tessier,
- Anne-Marie Mansour,
- Sara Hussein,
- Vincent Morin,
- Eric Rich,
- Jean-Richard Goulet,
- Sandra Chartrand,
- Marie Hudson,
- Jessica Nehme,
- Jean-Paul Makhzoum,
- Farah Zarka,
- Edith Villeneuve,
- Jean-Pierre Raynauld,
- Marianne Landry,
- Erin K. O’Ferrall,
- Jose Ferreira,
- Benjamin Ellezam,
- Jason Karamchandani,
- Sandrine Larue,
- Rami Massie,
- Catherine Isabelle,
- Isabelle Deschênes,
- Valérie Leclair,
- Hélène Couture,
- Ira N. Targoff,
- Marvin J. Fritzler,
- Jean-Luc Senécal
Affiliations
- Alain Meyer
- Faculté de médecine, Université de Strasbourg, Service de rhumatologie et Centre de références des maladies autoimmunes rares, Hôpitaux universitaires de Strasbourg
- Yves Troyanov
- Department of Medicine, Faculty of Medicine, University of Montreal
- Julie Drouin
- Department of Medicine, Faculty of Medicine, University of Montreal
- Geneviève Oligny-Longpré
- Department of Medicine, Faculty of Medicine, University of Montreal
- Océane Landon-Cardinal
- Department of Medicine, Faculty of Medicine, University of Montreal
- Sabrina Hoa
- Department of Medicine, Faculty of Medicine, University of Montreal
- Baptiste Hervier
- Service de médecine interne et immunologie clinique, Hôpital Pitié-Salpêtrière, Assistance publique Hôpitaux de Paris
- Josiane Bourré-Tessier
- Department of Medicine, Faculty of Medicine, University of Montreal
- Anne-Marie Mansour
- Department of Medicine, Faculty of Medicine, University of Montreal
- Sara Hussein
- Department of Medicine, Faculty of Medicine, University of Montreal
- Vincent Morin
- Faculty of Pharmacy, Laval University
- Eric Rich
- Department of Medicine, Faculty of Medicine, University of Montreal
- Jean-Richard Goulet
- Department of Medicine, Faculty of Medicine, University of Montreal
- Sandra Chartrand
- Department of Medicine, Faculty of Medicine, University of Montreal
- Marie Hudson
- Department of Medicine, McGill University
- Jessica Nehme
- Department of Medicine, Faculty of Medicine, University of Montreal
- Jean-Paul Makhzoum
- Department of Medicine, Faculty of Medicine, University of Montreal
- Farah Zarka
- Department of Medicine, Faculty of Medicine, University of Montreal
- Edith Villeneuve
- Department of Medicine, Faculty of Medicine, University of Montreal
- Jean-Pierre Raynauld
- Department of Medicine, Faculty of Medicine, University of Montreal
- Marianne Landry
- Department of Medicine, Faculty of Medicine, University of Montreal
- Erin K. O’Ferrall
- Department of Neurology, McGill University
- Jose Ferreira
- Department of Pathology and Cell Biology, Faculty of Medicine, University of Montreal
- Benjamin Ellezam
- Department of Pathology and Cell Biology, Faculty of Medicine, University of Montreal
- Jason Karamchandani
- Montreal Neurological Institute and Hospital
- Sandrine Larue
- Department of Medicine, Sherbrooke University
- Rami Massie
- Department of Neurology, McGill University
- Catherine Isabelle
- Department of Medicine, Sherbrooke University
- Isabelle Deschênes
- Department of Medicine, Sherbrooke University
- Valérie Leclair
- Department of Medicine, McGill University
- Hélène Couture
- Departement of Medicine, Laval University
- Ira N. Targoff
- Veterans Affairs Medical Center, University of Oklahoma Health Sciences Center
- Marvin J. Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary
- Jean-Luc Senécal
- Department of Medicine, Faculty of Medicine, University of Montreal
- DOI
- https://doi.org/10.1186/s13075-019-2093-6
- Journal volume & issue
-
Vol. 22,
no. 1
pp. 1 – 10
Abstract
Abstract Objective To describe successful therapeutic strategies in statin-induced anti-HMGCR myopathy. Methods Retrospective data from a cohort of 55 patients with statin-induced anti-HMGCR myopathy, sequentially stratified by the presence of proximal weakness, early remission, and corticosteroid and IVIG use at treatment induction, were analyzed for optimal successful induction and maintenance of remission strategies. Results A total of 14 patients achieved remission with a corticosteroid-free induction strategy (25%). In 41 patients treated with corticosteroids, only 4 patients (10%) failed an initial triple steroid/IVIG/steroid-sparing immunosuppressant (SSI) induction strategy. Delay in treatment initiation was independently associated with lower odds of successful maintenance with immunosuppressant monotherapy (OR 0.92, 95% CI 0.85 to 0.97, P = 0.015). While 22 patients (40%) presented with normal strength, only 9 had normal strength at initiation of treatment. Conclusion While corticosteroid-free treatment of anti-HMGCR myopathy is now a safe option in selected cases, initial triple steroid/IVIG/SSI was very efficacious in induction. Delays in treatment initiation and, as a corollary, delays in achieving remission decrease the odds of achieving successful maintenance with an SSI alone. Avoiding such delays, most notably in patients with normal strength, may reset the natural history of anti-HMGCR myopathy from a refractory entity to a treatable disease.
Keywords
- Autoimmune myositis
- Immune-mediated necrotizing myopathy
- Anti-HMGCR myopathy
- Statin
- Therapy
- Corticosteroid-free therapy
