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Argov Z. Statins in hereditary myopathies: to give or not to give. Neuromuscul Disord 2024; 41:35-39. [PMID: 38889624 DOI: 10.1016/j.nmd.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/31/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
Hyperlipidemia is not uncommon in patients with hereditary myopathies who get older and also in several conditions in which it is frequently observed. Thus, using the common cholesterol reducing medications of the stains group could be considered. However, the side effects of these drugs include myalgia, myopathy and rhabdomyolysis typically associated with high serum creatine kinase (CK). Because high CK levels are very frequently found in hereditary myopathies, physicians are reluctant to use statins in such patients. Reviewing the literature about statin side effects in hereditary myopathies does not provide a clear evidence about the true risk of these drugs. This review critically describes the reported cases of statin side effects in several genetic myopathies and suggests some guidelines for conditions that are contra indicated for statin usage (particularly in mitochondrial disorders, metabolic myopathies, myotonic dystrophy type 2). Possible solutions to the dilemma of whether to use statins in hereditary myopathies are discussed (prescribing other cholesterol lowering agents and a carefully monitored treatment initiation of statins).
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Affiliation(s)
- Zohar Argov
- Department of Neurology, Hadassah Medical Center and the Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
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2
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Caravan S, Lopez CM, Yeh JE. Causes and Clinical Presentation of Drug-Induced Dermatomyositis: A Systematic Review. JAMA Dermatol 2024; 160:210-217. [PMID: 38198130 DOI: 10.1001/jamadermatol.2023.5418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Importance While several medications are known to induce dermatomyositis (DM), most existing studies are case reports or small case series from a single institution. There is also limited information on DM induced by immune checkpoint inhibitors, which are increasingly used in oncologic therapy. Objective To characterize causes and clinical presentation of drug-induced DM based on the current literature. Evidence Review A systematic review was performed in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines, from inception to August 22, 2022. Articles meeting preestablished inclusion criteria (written in English and classified as original articles, case reports, literature reviews, and observation letters) were selected and data abstracted. Articles that met the scope of the review were also added from reference lists. When possible, study results were quantitatively combined. Findings In 134 studies (114 from the literature search and 20 additional studies pulled from reference lists) describing 165 cases, 88 patients (53.3%) were female, and the median (IQR) age was 61 (49-69) years. Among the cases of drug-induced DM, the most common associated medications were hydroxyurea (50 [30.3%]), immune checkpoint inhibitors (27 [16.4%]), statins (22 [13.3%]), penicillamine (10 [6.1%]), and tumor necrosis factor inhibitors (10 [6.1%]). Histopathologic testing, when undertaken, helped establish the diagnosis. There was a median (IQR) of 60 (21-288) days between drug initiation and drug-induced DM onset. History of cancer was reported in 85 cases (51.6%). Conclusions and Relevance In this systematic review, drug-induced DM was associated with multiple types of medications, including chemotherapies and immunotherapies. It is essential that dermatologists promptly recognize and diagnose drug-induced DM so that they can guide management to minimize interruption of therapy when possible.
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Affiliation(s)
- Sahar Caravan
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Christopher M Lopez
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Jennifer E Yeh
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
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3
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Che WI, Lundberg IE, Holmqvist M. Environmental Risks for Inflammatory Myopathies. Rheum Dis Clin North Am 2022; 48:861-874. [PMID: 36333000 DOI: 10.1016/j.rdc.2022.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This is an up-to-date review on external environmental factors for adult-onset idiopathic inflammatory myopathies (IIMs). Environmental factors with suggestive evidence including ultraviolet radiation, smoking, infectious agents (viruses in particular), pollutants, medications (ie, statin) and vitamin D deficiency are discussed. We also discuss the potential implications of environmental factors in IIM development, identify current challenges, and provide insight into future investigations.
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Affiliation(s)
- Weng Ian Che
- Department of Medicine, Solna, Eugeniahemmet, T2, Karolinska Universitetssjukhuset, Solna, Stockholm 171 76, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid E Lundberg
- Rheumatology, Karolinska University Hospital, Anna Steckséns gata 30A, Stockholm 171 76, Sweden; Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; ME Gastro, Derm and Rheuma, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
| | - Marie Holmqvist
- Department of Medicine, Solna, Eugeniahemmet, T2, Karolinska Universitetssjukhuset, Solna, Stockholm 171 76, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Rheumatology, Karolinska University Hospital, Anna Steckséns gata 30A, Stockholm 171 76, Sweden; Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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4
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Visconti MJ, Bashyam AM, Jorizzo JL. Statin‐induced dermatomyositis for the practicing dermatologist: a review of the literature. Int J Dermatol 2019; 59:383-387. [DOI: 10.1111/ijd.14751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/11/2019] [Accepted: 11/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Michael J. Visconti
- Center for Dermatology Research Department of Dermatology Wake Forest School of Medicine Winston‐Salem NC USA
| | - Arjun M. Bashyam
- Center for Dermatology Research Department of Dermatology Wake Forest School of Medicine Winston‐Salem NC USA
| | - Joseph L. Jorizzo
- Center for Dermatology Research Department of Dermatology Wake Forest School of Medicine Winston‐Salem NC USA
- Department of Dermatology Weill Cornell Medical College New York NY USA
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5
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Caughey GE, Gabb GM, Ronson S, Ward M, Beukelman T, Hill CL, Limaye V. Association of Statin Exposure With Histologically Confirmed Idiopathic Inflammatory Myositis in an Australian Population. JAMA Intern Med 2018; 178:1224-1229. [PMID: 30073275 PMCID: PMC6142971 DOI: 10.1001/jamainternmed.2018.2859] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Statin medications are widely prescribed for cardiovascular risk reduction. Myalgia and rhabdomyolysis are well-recognized adverse effects of statins, and they resolve with the cessation of statin therapy. Idiopathic inflammatory myositis (IIM) is a heterogeneous group of autoimmune myopathies that may also be associated with statin use. Recently, statin-associated autoimmune myopathy has been recognized as a distinct entity with the presence of specific autoantibodies against hydroxymethylglutaryl-coenzyme A reductase, which results in a necrotizing myositis that does not resolve with cessation of statin therapy and requires treatment with immunosuppressive agents. OBJECTIVE To examine the association between histologically confirmed IIM and current exposure to statin medications. DESIGN, SETTING, AND PARTICIPANTS Population-based case-control study using the South Australian Myositis Database of all histologically confirmed cases of IIM diagnosed between 1990 and 2014 in patients 40 years or older (n = 221) and population-based controls from the North West Adelaide Health Study (n = 662), matched by age and sex in a 3:1 ratio of controls to cases. Data analysis using conditional logistic regression was performed from June 1, 2016, to July 14, 2017. EXPOSURES Current statin medication use. MAIN OUTCOMES AND MEASURES Unadjusted and adjusted (for diabetes and cardiovascular disease) odds ratios and 95% CIs for likelihood of inflammatory myositis. RESULTS A total of 221 IIM cases met the inclusion criteria with a mean (SD) age of 62.2 (10.8) years, and 132 (59.7%) were female. Statin exposure at the time of IIM diagnosis was 68 of 221 patients (30.8%) and 142 of 662 matched controls (21.5%) (P = .005). There was an almost 2-fold increased likelihood of statin exposure in patients with IIM compared with controls (adjusted odds ratio, 1.79; 95% CI, 1.23-2.60; P = .001). Similar results were observed when patients with necrotizing myositis were excluded from the analysis (adjusted odds ratio, 1.92; 95% CI, 1.29-2.86; P = .001). CONCLUSIONS AND RELEVANCE In this large population-based study, statin exposure was significantly associated with histologically confirmed IIM. Given the increased use of statins worldwide and the severity of IIM, increased awareness and recognition of this potentially rare adverse effect of statin exposure is needed.
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Affiliation(s)
- Gillian E Caughey
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Genevieve M Gabb
- General Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Department of Medicine, University of Adelaide, Adelaide, Australia.,Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Australia
| | - Saffron Ronson
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Michael Ward
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Timothy Beukelman
- Division of Rheumatology, Department of Pediatrics, University of Alabama at Birmingham
| | - Catherine L Hill
- Department of Medicine, University of Adelaide, Adelaide, Australia.,Department of Rheumatology, The Queen Elizabeth Hospital, Woodville, Australia.,The Health Observatory, Discipline of Medicines, University of Adelaide, Adelaide, Australia.,Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Vidya Limaye
- Department of Medicine, University of Adelaide, Adelaide, Australia.,Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia
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Woolley M, Stebbings S, Highton J. Statin-associated immune-mediated necrotising myopathy: a New Zealand case series showing possible overrepresentation in Pacific Islanders. Intern Med J 2018; 48:32-36. [DOI: 10.1111/imj.13575] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/06/2017] [Accepted: 07/30/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Michelle Woolley
- Department of Rheumatology; Dunedin Hospital; Dunedin New Zealand
| | - Simon Stebbings
- Department of Medicine, Dunedin school of Medicine; University of Otago; Dunedin New Zealand
| | - John Highton
- Department of Medicine, Dunedin school of Medicine; University of Otago; Dunedin New Zealand
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7
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Lipid-lowering agent-triggered dermatomyositis and polymyositis: a case series and literature review. Rheumatol Int 2017; 38:293-301. [DOI: 10.1007/s00296-017-3821-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
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8
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Fania L, Didona D, Tonanzi T, Mazzanti C, Didona B. Simvastatin-associated dermatomyositis. Dermatol Ther 2017; 30. [DOI: 10.1111/dth.12480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 02/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Luca Fania
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM; via dei Monti di Creta 104 Rome 00167 Italy
| | - Dario Didona
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM; via dei Monti di Creta 104 Rome 00167 Italy
| | - Tiziano Tonanzi
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM; via dei Monti di Creta 104 Rome 00167 Italy
| | - Cinzia Mazzanti
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM; via dei Monti di Creta 104 Rome 00167 Italy
| | - Biagio Didona
- Istituto Dermopatico dell'Immacolata-IRCCS, FLMM; via dei Monti di Creta 104 Rome 00167 Italy
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9
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Ruaño G, Seip R, Windemuth A, Wu AHB, Thompson PD. Laboratory Medicine in the Clinical Decision Support for Treatment of Hypercholesterolemia: Pharmacogenetics of Statins. Clin Lab Med 2016; 36:473-91. [PMID: 27514463 DOI: 10.1016/j.cll.2016.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Statin responsiveness is an area of great research interest given the success of the drug class in the treatment of hypercholesterolemia and in primary and secondary prevention of cardiovascular disease. Interrogation of the patient's genome for gene variants will eventually guide anti-hyperlipidemic intervention. In this review, we discuss methodological approaches to discover genetic markers predictive of class-wide and drug-specific statin efficacy and safety. Notable pharmacogenetic findings are summarized from hypothesis-free genome wide and hypothesis-led candidate gene association studies. Physiogenomic models and clinical decision support systems will be required for DNA-guided statin therapy to reach practical use in medicine.
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Affiliation(s)
| | - Richard Seip
- Sanofi Genzyme, 500 Kendall Street, Cambridge, MA 02142, USA
| | | | - Alan H B Wu
- Department of Laboratory Medicine, San Francisco General Hosptial, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - Paul D Thompson
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06106, USA
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10
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Tseng CC, Chang SJ, Liao WT, Chan YT, Tsai WC, Ou TT, Wu CC, Sung WY, Hsieh MC, Yen JH. Increased Cumulative Incidence of Dermatomyositis in Ulcerative Colitis: a Nationwide Cohort Study. Sci Rep 2016; 6:28175. [PMID: 27325143 PMCID: PMC4914943 DOI: 10.1038/srep28175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/31/2016] [Indexed: 12/19/2022] Open
Abstract
On a molecular level, two autoimmune diseases: ulcerative colitis (UC) and dermatomyositis share common genetic determinants. On a clinical level, case reports evidenced the co-occurrence of these two diseases. We therefore hypothesize that UC is potentially associated with increased cumulative incidence of dermatomyositis. The goals of this retrospective cohort study were to evaluate whether UC is associated with increased cumulative incidence of dermatomyositis independent of sex and age. For comparison, we also assessed the cumulative incidence of polymyositis in UC and control subjects. The study enrolled 3,133 UC subjects and 14,726 control subjects. The cumulative incidence of dermatomyositis was significantly higher in UC than that of control subjects (p = 0.026), but the cumulative incidence of polymyositis was comparable between UC and control subjects (p = 0.596). UC was independently associated with the increased incident dermatomyositis (hazard ratio: 6.19, 95% confidence interval = 1.77-21.59, p = 0.004) after adjusting for sex, age, and concomitant rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis. Similar trends of increased dermatomyositis in UC were observed when patients were stratified based on sex and age. In conclusion, our findings suggest that UC is probably associated with increased cumulative incidence of dermatomyositis, independent of sex, age, and concomitant autoimmune diseases.
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Affiliation(s)
- Chia-Chun Tseng
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Shun-Jen Chang
- Department of Kinesiology, Health and Leisure Studies, National University of Kaohsiung, Kaohsiung, Taiwan
| | - Wei-Ting Liao
- Department of Biotechnology, College of Life Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Ting Chan
- Department of Kinesiology, Health and Leisure Studies, National University of Kaohsiung, Kaohsiung, Taiwan
| | - Wen-Chan Tsai
- Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tsan-Teng Ou
- Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Cheng-Chin Wu
- Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wan-Yu Sung
- Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Chia Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Jeng-Hsien Yen
- Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
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11
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Pugnet G, Sailler L, Bourrel R, Montastruc JL, Lapeyre-Mestre M. Is statin exposure associated with occurrence or better outcome in giant cell arteritis? Results from a French population-based study. J Rheumatol 2014; 42:316-22. [PMID: 25512477 DOI: 10.3899/jrheum.140906] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the potential association between statin use and giant cell arteritis (GCA) course. METHODS Using the French National Health Insurance system, we included patients with incident GCA from the Midi-Pyrenees region, southern France, from January 2005 to December 2008 and randomly selected 6 controls matched by age, sex, and date of diagnosis. Statin exposure was compared between patients with GCA and their controls before GCA occurrence with a logistic regression. Influence of statin exposure on prednisone requirements during GCA course was explored with a Cox model, considering statin exposure as a time-varying variable. RESULTS The cohort included 103 patients (80 women, mean age 74.8 ± 9 yrs, mean followup 48.9 ± 14.8 mos), compared to 606 controls. Statin exposure (27.2% of patients with GCA and 23.4% of controls) was not associated with GCA occurrence (adjusted OR 1.2, 95% CI 0.76-1.96; p = 0.41). Diabetes mellitus was significantly associated to GCA occurrence (adjusted OR 0.38, 95% CI 0.11-0.72; p = 0.008). After diagnosis, exposure to statins up to 20 months was associated with maintenance while taking low prednisone doses (p = 0.01). CONCLUSION Statin exposure was not associated with GCA occurrence in the general population. However, exposure to statins up to 20 months may favor a quicker corticosteroid tapering. Based on those results, statin effect on GCA course should not be definitively ruled out.
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Affiliation(s)
- Grégory Pugnet
- From the Faculté de Médecine, and the Laboratoire de Pharmacologie Médicale et Clinique, Université de Toulouse III; INSERM, UMR1027; Service de Médecine Interne, and the Service de Pharmacologie Clinique, Centre Hospitalier Universitaire (CHU) Toulouse; Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Service Médical Midi-Pyrénées, Toulouse, France.G. Pugnet, MD; L. Sailler, MD, PhD, Université de Toulouse III, INSERM, UMR1027, Service de Médecine Interne, CHU Toulouse; R. Bourrel, MD, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Service Médical Midi-Pyrénées; J-L. Montastruc, MD, PhD; M. Lapeyre-Mestre, MD, PhD, Université de Toulouse III, INSERM, UMR1027, Laboratoire de Pharmacologie Médicale et Clinique, Université de Toulouse III, Service de Pharmacologie Clinique, CHU Toulouse.
| | - Laurent Sailler
- From the Faculté de Médecine, and the Laboratoire de Pharmacologie Médicale et Clinique, Université de Toulouse III; INSERM, UMR1027; Service de Médecine Interne, and the Service de Pharmacologie Clinique, Centre Hospitalier Universitaire (CHU) Toulouse; Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Service Médical Midi-Pyrénées, Toulouse, France.G. Pugnet, MD; L. Sailler, MD, PhD, Université de Toulouse III, INSERM, UMR1027, Service de Médecine Interne, CHU Toulouse; R. Bourrel, MD, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Service Médical Midi-Pyrénées; J-L. Montastruc, MD, PhD; M. Lapeyre-Mestre, MD, PhD, Université de Toulouse III, INSERM, UMR1027, Laboratoire de Pharmacologie Médicale et Clinique, Université de Toulouse III, Service de Pharmacologie Clinique, CHU Toulouse
| | - Robert Bourrel
- From the Faculté de Médecine, and the Laboratoire de Pharmacologie Médicale et Clinique, Université de Toulouse III; INSERM, UMR1027; Service de Médecine Interne, and the Service de Pharmacologie Clinique, Centre Hospitalier Universitaire (CHU) Toulouse; Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Service Médical Midi-Pyrénées, Toulouse, France.G. Pugnet, MD; L. Sailler, MD, PhD, Université de Toulouse III, INSERM, UMR1027, Service de Médecine Interne, CHU Toulouse; R. Bourrel, MD, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Service Médical Midi-Pyrénées; J-L. Montastruc, MD, PhD; M. Lapeyre-Mestre, MD, PhD, Université de Toulouse III, INSERM, UMR1027, Laboratoire de Pharmacologie Médicale et Clinique, Université de Toulouse III, Service de Pharmacologie Clinique, CHU Toulouse
| | - Jean-Louis Montastruc
- From the Faculté de Médecine, and the Laboratoire de Pharmacologie Médicale et Clinique, Université de Toulouse III; INSERM, UMR1027; Service de Médecine Interne, and the Service de Pharmacologie Clinique, Centre Hospitalier Universitaire (CHU) Toulouse; Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Service Médical Midi-Pyrénées, Toulouse, France.G. Pugnet, MD; L. Sailler, MD, PhD, Université de Toulouse III, INSERM, UMR1027, Service de Médecine Interne, CHU Toulouse; R. Bourrel, MD, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Service Médical Midi-Pyrénées; J-L. Montastruc, MD, PhD; M. Lapeyre-Mestre, MD, PhD, Université de Toulouse III, INSERM, UMR1027, Laboratoire de Pharmacologie Médicale et Clinique, Université de Toulouse III, Service de Pharmacologie Clinique, CHU Toulouse
| | - Maryse Lapeyre-Mestre
- From the Faculté de Médecine, and the Laboratoire de Pharmacologie Médicale et Clinique, Université de Toulouse III; INSERM, UMR1027; Service de Médecine Interne, and the Service de Pharmacologie Clinique, Centre Hospitalier Universitaire (CHU) Toulouse; Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Service Médical Midi-Pyrénées, Toulouse, France.G. Pugnet, MD; L. Sailler, MD, PhD, Université de Toulouse III, INSERM, UMR1027, Service de Médecine Interne, CHU Toulouse; R. Bourrel, MD, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Service Médical Midi-Pyrénées; J-L. Montastruc, MD, PhD; M. Lapeyre-Mestre, MD, PhD, Université de Toulouse III, INSERM, UMR1027, Laboratoire de Pharmacologie Médicale et Clinique, Université de Toulouse III, Service de Pharmacologie Clinique, CHU Toulouse
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Abstract
AbstractBackgroundStatins have recently been reported to cause a rare autoimmune inflammatory and/or necrotic myopathy that begins or persists after drug cessation.MethodsWe report on 26 patients seen at a neuromuscular centre between 2005 and 2011 who demonstrated muscle weakness/myalgias and creatine kinase elevations during or after statin treatment with continuation of signs and symptoms despite statin withdrawal.ResultsAll patients were treated with immunosuppressive therapy with good response; all improved biochemically and 86% improved clinically. Sixty-five percent of patients who attempted to taper off immunosuppressive therapy relapsed. We report on a novel finding whereby five of the seven patients who underwent multiple biopsies throughout their disease demonstrated a transformation of their histological diagnosis, with four progressing from having myofibre necrosis with minimal or no inflammation to a diagnosis of polymyositis.ConclusionsThis study offers preliminary evidence that statin-associated necrotizing myopathy and statin-associated polymyositis may not be separate entities but are part of the same pathophysiological spectrum. Both entities respond well to immunosuppression.
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13
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Hinschberger O, Lohmann C, Lannes B, Martzolff L, Vo B, Jaeger-Bizet F, Ciobanu E, Kieffer P. Myopathie nécrosante auto-immune associée aux anticorps anti-hydroxy-méthyl-glutaryl-coenzyme A réductase. Rev Med Interne 2014; 35:546-9. [DOI: 10.1016/j.revmed.2013.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 05/02/2013] [Accepted: 06/23/2013] [Indexed: 10/26/2022]
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14
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Gabb GM, Vitry A, Condon J, Limaye V, Alhami G. Serious statin-associated myotoxicity and rhabdomyolysis in Aboriginal and Torres Strait Islanders: a case series. Intern Med J 2014; 43:987-92. [PMID: 23692462 DOI: 10.1111/imj.12196] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 05/08/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Statins are associated with skeletal muscle adverse effects. These are generally considered mild and reversible, with more severe toxicity occurring rarely. There is little known regarding statin myotoxicity in Aboriginal and Torres Strait Islander Australians who are at high cardiovascular risk and likely to receive statins. AIMS To describe features of serious statin-associated myotoxicity (SSAM) occurring in Indigenous Australians and increase awareness of this condition. METHODS Observational case series of SSAM in Aboriginal or Torres Strait Islanders. Cases were identified from personal clinical experience, referrals, reports to the Therapeutic Goods Administration, medical literature, an Internet search and reports from a histopathology laboratory. Information was collected onto a standardised data collection form. RESULTS Fifteen cases of serious myotoxicity in Aboriginal or Torres Strait Islanders exposed to statins were identified from 2006 to 2012. The mean age was 55 (range 35-69). Painless weakness was the most common presentation. Interacting drugs were involved in seven cases. Biopsies were done in eight cases, three showed inflammatory polymyositis and five necrotising myositis. Three patients died and two had permanent severe disability. Resolution of symptoms after statin cessation was variable. CONCLUSIONS SSAM has occurred in the Indigenous Australian population with some fatalities. Awareness of the potential for SSAM is essential for early recognition and effective management to reduce probability of avoidable catastrophic harm. Safe, as well as effective use of medication, is essential for optimum health outcomes. Effective pharmacovigilance and therapeutic risk management are important for Aboriginal and Torres Strait Islander Australians.
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Affiliation(s)
- G M Gabb
- Department of General Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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Needham M, Mastaglia FL. Statin myotoxicity: a review of genetic susceptibility factors. Neuromuscul Disord 2013; 24:4-15. [PMID: 24176465 DOI: 10.1016/j.nmd.2013.09.011] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/08/2013] [Accepted: 09/20/2013] [Indexed: 12/11/2022]
Abstract
The 3-hydroxy-3-methylglutaryl coenzyme A (HMGCoA) reductase inhibitors (statins) are among the most common medications prescribed worldwide, but their efficacy and toxicity vary between individuals. One of the major factors contributing to intolerance and non-compliance are the muscle side-effects, which range from mild myalgia through to severe life-threatening rhabdomyolysis. One way to address this is pharmacogenomic screening, which aims to individualize therapy to maximize efficacy whilst avoiding toxicity. Genes encoding proteins involved in the metabolism of statins as well as genes known to cause inherited muscle disorders have been investigated. To-date only polymorphisms in the SLCO1B1 gene, which encodes the protein responsible for hepatic uptake of statins, and the COQ2 gene, important in the synthesis of coenzyme Q10, have been validated as being strongly associated with statin-induced myopathy. The aim of this review is to summarize studies investigating genetic factors predisposing to statin myopathy and myalgia, as the first step towards pharmacogenomic screening to identify at risk individuals.
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Affiliation(s)
- M Needham
- Australian Neuromuscular Research Institute, Centre for Neuromuscular & Neurological Disorders, University of Western Australia, Australia.
| | - F L Mastaglia
- Australian Neuromuscular Research Institute, Centre for Neuromuscular & Neurological Disorders, University of Western Australia, Australia
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17
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Abstract
Statins are an extensively used class of drugs, and myopathy is an uncommon, but well-described side effect of statin therapy. Inflammatory myopathies, including polymyositis, dermatomyositis, and necrotizing autoimmune myopathy, are even more rare, but debilitating, side effects of statin therapy that are characterized by the persistence of symptoms even after discontinuation of the drug. It is important to differentiate statin-associated inflammatory myopathies from other self-limited myopathies, as the disease often requires multiple immunosuppressive therapies. Drug interactions increase the risk of statin-associated toxic myopathy, but no risk factors for statin-associated inflammatory myopathies have been established. Here we describe the case of a man, age 59 years, who had been treated with a combination of atorvastatin and gemfibrozil for approximately 5 years and developed polymyositis after treatment with omeprazole for 7 months. Symptoms did not resolve after discontinuation of the atorvastatin, gemfibrozil, and omeprazole. The patient was treated with prednisone and methotrexate followed by intravenous immunoglobulin, which resulted in normalization of creatinine kinase levels and resolution of symptoms after 14 weeks. It is unclear if polymyositis was triggered by interaction of the statin with omeprazole and/or gemfibrozil, or if it developed secondary to long-term use of atorvastatin only.
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Affiliation(s)
- Rajan Kanth
- Department of Internal Medicine, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
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18
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Lazarou IN, Guerne PA. Classification, diagnosis, and management of idiopathic inflammatory myopathies. J Rheumatol 2013; 40:550-64. [PMID: 23504386 DOI: 10.3899/jrheum.120682] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The detection and characterization of a large array of autoantibodies, including at least 8 different antisynthetase, anti-SRP, -200/100 (HMGCR), -Mi-2, -CADM-140 (MDA5), -SAE, -p155, -MJ (NXP-2), and -PMS1, frequently associated with distinct and well-defined clinicopathological features, allowed for significant improvement in the definition and diagnosis of idiopathic inflammatory myopathies (IIM). Classification remains difficult, with lingering divergence between the different specialties involved in IIM care, but several categories clearly stand out, including dermatomyositis (DM), overlap myositis (OM), polymyositis, necrotizing myositis, and sporadic inclusion body myositis (s-IBM). Biopsy and histological analysis remain crucial, particularly in the absence of autoantibodies, to accurately specify the diagnosis and rule out mimics such as muscular dystrophies and metabolic myopathies. Numerous infectious agents (in particular human immunodeficiency virus and human T cell lymphotrophic virus-1) and drugs (statins, tumor necrosis factor inhibitors, and proton pump inhibitors) can cause mimic IIM that must also be excluded. Pharmacological treatment, in addition to glucocorticoids and immunoglobulins, now includes mycophenolate mofetil and rituximab, which proved helpful in resistant cases, particularly rituximab in DM and OM. Exercise, initially seen as potentially deleterious, recently was shown to be efficacious and safe. IIM can thus be reasonably well controlled in most cases, although aggressive disease remains refractory to treatment, including some cases of necrotizing myopathy. Sporadic IBM still seems resistant to all medications tested to date.
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Affiliation(s)
- Ilias N Lazarou
- Department of Rheumatology, University Hospital of Geneva, Geneva, Switzerland.
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19
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Abstract
Statins are an effective treatment for the prevention of cardiovascular diseases and used extensively worldwide. However, myotoxicity induced by statins is a common adverse event and a major barrier to maximising cardiovascular risk reduction. The clinical spectrum of statin induced myotoxicity includes asymptomatic rise in creatine kinase concentration, myalgia, myositis and rhabdomyolysis. In certain cases, the cessation of statin therapy does not result in the resolution of muscular symptoms or the normalization of creatine kinase, raising the possibility of necrotizing autoimmune myopathy. There is increasing understanding and recognition of the pathophysiology and risk factors of statin induced myotoxicity. Careful history and physical examination in conjunction with selected investigations such as creatine kinase measurement, electromyography and muscle biopsy in appropriate clinical scenario help diagnose the condition. The management of statin induced myotoxicity involves statin cessation, the use of alternative lipid lowering agents or treatment regimes, and in the case of necrotizing autoimmune myopathy, immunosuppression.
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Affiliation(s)
- Sivakumar Sathasivam
- The Walton Centre NHS Foundation Trust, Lower Lane, Liverpool L9 7LJ, United Kingdom.
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20
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Dimitri D, Eymard B. Myopathies inflammatoires, myopathies nécrosantes auto-immunes, myopathies génétiques de l’adulte : frontières diagnostiques. Rev Med Interne 2012; 33:134-42. [DOI: 10.1016/j.revmed.2011.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 11/26/2011] [Indexed: 10/14/2022]
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21
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Moulis G, Béné J, Sommet A, Sailler L, Lapeyre-Mestre M, Montastruc JL. Statin-induced lupus: a case/non-case study in a nationwide pharmacovigilance database. Lupus 2012; 21:885-9. [DOI: 10.1177/0961203312436861] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Statin use has been advocated to prevent atheromatous complications in lupus patients and may be widely prescribed for these patients in future. Statin-induced lupus has also been described, though the risk is not confirmed. The goal of this study was to detect a safety signal regarding statin-induced lupus. We conducted a case/non-case study in the French PharmacoVigilance Database from January 2000 until December 2010. Cases were drug-induced lupus reports. Non-cases were all reports of other adverse drug reactions (ADRs). Exposure to statins at the time of ADR was screened in each report. Among 235,147 ADR reports, 232 were drug-induced lupus. Exposure to statins was present in 17 (7.3%) cases and in 10,601 (4.7%) non-cases. Reporting odds ratio (ROR) for statin exposure associated with lupus erythematosus was 1.67 (95% confidence interval 1.02–2.74). The ROR was > 1 for each statin but fluvastatin. This pharmacoepidemiological study suggests a link between statin exposure and lupus induction. The benefit-to-risk ratio of statin therapy in lupus patients should be evaluated through randomized controlled trials.
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Affiliation(s)
- G Moulis
- CHU Toulouse, Service de Médecine Interne, Toulouse, F-31059, France
- CHU Toulouse, Service de Pharmacologie Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d’Informations sur le Médicament, Toulouse, F-31059, France
- Inserm, UMR1027, Toulouse, F-31073, France
- Université de Toulouse III, UMR1027, Toulouse, F-31073, France
| | - J Béné
- CHU Lille, Centre Nord-Pas de Calais de PharmacoVigilance, Lille, F-59037, France
| | - A Sommet
- CHU Toulouse, Service de Pharmacologie Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d’Informations sur le Médicament, Toulouse, F-31059, France
- Inserm, UMR1027, Toulouse, F-31073, France
- Université de Toulouse III, UMR1027, Toulouse, F-31073, France
| | - L Sailler
- CHU Toulouse, Service de Médecine Interne, Toulouse, F-31059, France
- CHU Toulouse, Service de Pharmacologie Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d’Informations sur le Médicament, Toulouse, F-31059, France
- Inserm, UMR1027, Toulouse, F-31073, France
- Université de Toulouse III, UMR1027, Toulouse, F-31073, France
| | - M Lapeyre-Mestre
- CHU Toulouse, Service de Pharmacologie Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d’Informations sur le Médicament, Toulouse, F-31059, France
- Inserm, UMR1027, Toulouse, F-31073, France
- Université de Toulouse III, UMR1027, Toulouse, F-31073, France
| | - J-L Montastruc
- CHU Toulouse, Service de Pharmacologie Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d’Informations sur le Médicament, Toulouse, F-31059, France
- Inserm, UMR1027, Toulouse, F-31073, France
- Université de Toulouse III, UMR1027, Toulouse, F-31073, France
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22
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Padala S, Thompson PD. Statins as a possible cause of inflammatory and necrotizing myopathies. Atherosclerosis 2011; 222:15-21. [PMID: 22154355 DOI: 10.1016/j.atherosclerosis.2011.11.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Revised: 11/08/2011] [Accepted: 11/08/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hydroxy-methyl-glutaryl Co-A reductase (HMGCR) inhibitors or statins are a well recognized cause of a variety of skeletal myopathic effects which generally resolve on stopping the medication. Recent reports, however, suggest that statins are associated with a unique autoimmune myopathy wherein symptoms persist or even progress after statin discontinuation and require immunosuppressive therapy. We performed a systematic review to examine the association of statins with inflammatory (dermatomyositis/polymyositis) and necrotizing myopathies. METHODS We searched PubMed, Ovid and Scopus for English language articles addressing statin associated inflammatory and necrotizing myopathies. Given the paucity of cases, we extended the search to include articles in all languages. RESULTS The search yielded 14 articles reporting a possible association of statins with inflammatory myopathies describing 10 cases of polymyositis and 14 cases of dermatomyositis, and 4 articles reporting a possible association of statins with necrotizing myopathies describing 63 cases. One study identified a unique antibody directed against HMGCR in patients with necrotizing myopathy. Systemic immunosuppressive therapy was required in majority of these cases for resolution of symptoms. CONCLUSION Statins have recently been associated with a variety of inflammatory myopathies including polymyositis, dermatomyositis, and a necrotizing myopathy. The association of statins with necrotizing myopathy is strengthened by the discovery that the serum of some of these patients contains an anti-HMGCR antibody. This suggests that statins can cause or unmask an immune mediated myopathy.
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Affiliation(s)
- Santosh Padala
- Department of Internal Medicine, University of Connecticut, Farmington, CT 06030, USA
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23
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24
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Mihos CG, Artola RT, Santana O. The pleiotropic effects of the hydroxy-methyl-glutaryl-CoA reductase inhibitors in rheumatologic disorders: a comprehensive review. Rheumatol Int 2011; 32:287-94. [PMID: 21805349 DOI: 10.1007/s00296-011-2008-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 07/10/2011] [Indexed: 01/22/2023]
Abstract
The hydroxy-methyl-glutaryl-CoA reductase inhibitors (statins) are used extensively in the treatment for hyperlipidemia. They have also demonstrated a benefit in a variety of other disease processes, including a wide range of rheumatologic disorders. These secondary actions are known as pleiotropic effects. Our paper serves as a focused and updated discussion on the pleiotropic effects of statins in rheumatologic disorders and emphasizes the importance of randomized, placebo-controlled trials to further elucidate this interesting phenomenon.
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Affiliation(s)
- Christos G Mihos
- Division of Cardiology, Mount Sinai Heart Institute, Columbia University, 4300 Alton Road, Miami Beach, FL 33140, USA
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25
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Zaraa IR, Labbène I, Mrabet D, Zribi H, Chelly I, Zitouna M, Mokni M, Sellami S, Ben Osman A. Simvastatin-induced dermatomyositis in a 50-year-old man. BMJ Case Rep 2011; 2011:2011/mar29_1/bcr0220113832. [PMID: 22700482 DOI: 10.1136/bcr.02.2011.3832] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Dermatomyositis (DM) is a rare inflammatory autoimmune disease for which an iatrogenic origin has been described in a few cases. The authors report a case of DM occurring after simvastatin intake. A 50-year-old male sought medical attention for a photodistributed rash and considerable muscular weakness present for 3 months. One year earlier, simvastatin had been introduced. Serum creatine kinase levels were elevated. Histological examination of a muscle biopsy was consistent with a diagnosis of DM. Investigation for neoplasia and associated autoimmune disease proved negative. All clinical and laboratory abnormalities diminished corticosteroid therapy (1 mg/kg/day). Case reports have suggested that lipid-lowering drugs, especially statins, could induce or reveal chronic muscle diseases. In statins myopathy, reduction of coenzyme Q has been discussed as a key mechanism. Our case of DM in a patient receiving simvastatin adds to the previous reported cases in the literature and highlights the potential role of statins as triggers of immune systemic diseases.
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26
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Martin-Latry K, Cougnard A. Terminologie utilisée concernant les bases de remboursement de l’assurance maladie en pharmaco-épidémiologie : une harmonisation nécessaire. Therapie 2010; 65:379-85. [DOI: 10.2515/therapie/2010047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 04/08/2010] [Indexed: 11/20/2022]
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Martin-Latry K, Bégaud B. Pharmacoepidemiological research using French reimbursement databases: yes we can! Pharmacoepidemiol Drug Saf 2010; 19:256-65. [PMID: 20128015 DOI: 10.1002/pds.1912] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To describe the reimbursement databases available in France for pharmacoepidemiological research and their use. METHODS France has a publicly funded health system that systematically covers the population. Within this system, three main insurance schemes provide health services to citizens in France and each have their own reimbursement database. Together these three databases cover almost 97% of the French population (respectively for 54.5, 3.6, and 3.3 million individuals, and a total of 61.4 million individuals). Data in these concern patients, prescribers, all the medical acts reimbursed, prescription and undertaking of laboratory tests (but without results), private hospital data, partial public hospital data and vital status. Their use is regulated but access is free and the data are anonymous. PubMed and Scopus were searched for relevant studies published from January 1988 to June 2009. RESULTS 110 published studies were included. The topics and the study characteristics were extremely wide-ranging. The studies assessed patterns of drug use, have tested interventions, supported or improved prescribing practices, tested compliance with the French governmental Health guidelines, assessed physicians' prescribing practices and performed economic and cost-effectiveness assessments. The number of articles published increased greatly between 2002 and 2003. CONCLUSIONS The French reimbursement databases were greatly used over the last 20 years. They can provide data on exposure to drugs and can be used to study patterns of drug utilization although their limitations must be considered.
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Affiliation(s)
- Karin Martin-Latry
- Département de Pharmacologie, Université Victor Segalen Bordeaux 2, 33076 Bordeaux, France.
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28
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Ghatak A, Faheem O, Thompson PD. The genetics of statin-induced myopathy. Atherosclerosis 2009; 210:337-43. [PMID: 20042189 DOI: 10.1016/j.atherosclerosis.2009.11.033] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 11/20/2009] [Accepted: 11/20/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Our goal was to use genetic variants to identify factors contributing to the muscular side effects of statins. BACKGROUND Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are usually well tolerated medications, but muscle symptoms, ranging from mild myalgia to clinically important rhabdomyolysis are an important side effect of these drugs and a leading cause of noncompliance. Recent results suggest that genetic factors increase the risk of statin-related muscle complaints. We performed a systematic review of the medical literature to determine genetic factors associated with statin myopathy. METHODS We identified English language articles relating statin myopathy and genetic diseases and gene variants via a PubMed search. Articles pertinent to the topic were reviewed in detail. RESULTS/CONCLUSIONS Our review suggests that some patients are susceptible to statin myopathy because of pre-existing subclinical inherited muscular disorders, or genetic variation in statin uptake proteins encoded by SLCO1B1 or the cytochrome P enzyme system. Variations in genes affecting pain perception and polymorphism in vascular receptors may also contribute to statin myopathy. None of the variants identified in this review suggested novel metabolic mechanisms leading to statin myopathy.
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Affiliation(s)
- Abhijit Ghatak
- Department of Internal Medicine, University of Connecticut, Farmington, CT 06032, USA
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Prevalence and correlates of musculoskeletal pain in Chinese elderly and the impact on 4-year physical function and quality of life. Public Health 2009; 123:549-56. [DOI: 10.1016/j.puhe.2009.07.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 06/25/2009] [Accepted: 07/15/2009] [Indexed: 11/23/2022]
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Deans KA, Dominiczak MH. Hyperlipidaemia and cardiovascular disease: apolipoprotein measurements and metabolic syndrome as predictors of cardiovascular risk. Curr Opin Lipidol 2008; 19:624-6. [PMID: 18957887 DOI: 10.1097/mol.0b013e328316c030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kevin A Deans
- Department of Biochemistry, Gartnavel General Hospital, Glasgow, UK
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Buettner C, Lecker SH. Molecular basis for statin-induced muscle toxicity: implications and possibilities. Pharmacogenomics 2008; 9:1133-42. [DOI: 10.2217/14622416.9.8.1133] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Statins are widely used to treat hypercholesterolemia, a known risk factor for atherosclerosis. These drugs can lead to a number of side effects in muscle, including rhabdomyolysis; however, the mechanism of muscle injury is poorly defined. We review the clinical characteristics of this diverse syndrome, as well as the biochemical mechanisms that might provide an explanation for the toxicity of these agents. New findings implicating atrogin-1, a gene required for muscle atrophy, in the pathophysiology of statin-induced muscle injury are discussed, as well as implications of these novel discoveries.
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Affiliation(s)
- Catherine Buettner
- General Medicine and Primary Care, Atrium Suite 1, Shapiro 1, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue Boston, MA, 02215 USA
| | - Stewart H Lecker
- Divisions of Nephrology, Renal Unit, DA517, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215 USA
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