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Voora D, Baye J, McDermaid A, Gowda SN, Wilke RA, Myrmoe AN, Hajek C, Larson EA. SLCO1B1*5 allele is associated with atorvastatin discontinuation and adverse muscle symptoms in the context of routine care. Clin Pharmacol Ther 2022; 111:1075-1083. [PMID: 35034348 PMCID: PMC9303592 DOI: 10.1002/cpt.2527] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/13/2021] [Accepted: 12/29/2021] [Indexed: 11/06/2022]
Abstract
SLCO1B1 genotype is known to influence patient adherence to statin therapy, in part by increasing the risk for statin-associated musculoskeletal symptoms (SAMS). The SLCO1B1*5 allele has previously been associated with simvastatin discontinuation and SAMS. Prior analyses of the relationship between SLCO1B1*5 and atorvastatin muscle side effects have been inconclusive due to insufficient power. We now quantify the impact of SLCO1B1*5 on atorvastatin discontinuation and SAMS in a large observational cohort using electronic medical record (EMR) data from a single health care system. In our study cohort (n = 1,627 patients exposed to atorvastatin during the course of routine clinical care), 56% (n = 912 of 1,627 patients) discontinued atorvastatin and 18% (n = 303 of 1,627 patients) developed SAMS. A univariate model revealed that SLCO1B1*5 increased the likelihood that patients would stop atorvastatin during routine care (Odds Ratio 1.2, 95% confidence interval [C.I.]: 1.1 - 1.5, p = 0.04). A multivariate Cox proportional hazards model further demonstrated that this same variant was associated with time to atorvastatin discontinuation (Hazard Ratio 1.2, C.I. 1.1 - 1.4, p = 0.004). Additional time-to-event analyses also revealed that SCLO1B1*5 was associated with SAMS (Hazard Ratio 1.4, C.I. 1.1 - 1.7, p = 0.02). Atorvastatin discontinuation was associated with SAMS (Odds Ratio 1.67, p = 0.0001) in our cohort.
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Affiliation(s)
- Deepak Voora
- Department of Medicine, Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, 27710
| | | | - Adam McDermaid
- Sanford Imagenetics, Sioux Falls, 57105.,Department of Internal Medicine, University of South Dakota, Sanford School of Medicine, Sioux Falls, 57105
| | - Smitha Narayana Gowda
- Department of Internal Medicine, University of South Dakota, Sanford School of Medicine, Sioux Falls, 57105
| | - Russell A Wilke
- Department of Internal Medicine, University of South Dakota, Sanford School of Medicine, Sioux Falls, 57105
| | - Anna Nicole Myrmoe
- Department of Internal Medicine, University of South Dakota, Sanford School of Medicine, Sioux Falls, 57105
| | - Catherine Hajek
- Sanford Imagenetics, Sioux Falls, 57105.,Department of Internal Medicine, University of South Dakota, Sanford School of Medicine, Sioux Falls, 57105
| | - Eric A Larson
- Sanford Imagenetics, Sioux Falls, 57105.,Department of Internal Medicine, University of South Dakota, Sanford School of Medicine, Sioux Falls, 57105
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