Statin-induced anti-HMGCR myopathy: successful therapeutic strategies for corticosteroid-free remission in 55 patients

Autor: Erin K. O'Ferrall, Farah Zarka, Jean-Paul Makhzoum, Ira N. Targoff, Isabelle Deschenes, Jason Karamchandani, Sabrina Hoa, Marvin J. Fritzler, Baptiste Hervier, Sara Hussein, Jose Ferreira, Marianne Landry, Marie Hudson, Eric Rich, Océane Landon-Cardinal, Jessica Nehme, Rami Massie, Anne-Marie Mansour, Josiane Bourré-Tessier, Jean-Richard Goulet, Edith Villeneuve, Geneviève Oligny-Longpré, Julie Drouin, Jean-Pierre Raynauld, Yves Troyanov, Catherine Isabelle, Benjamin Ellezam, Alain Meyer, Valérie Leclair, Sandra Chartrand, Sandrine Larue, Hélène Couture, Vincent Morin, Jean-Luc Senécal
Rok vydání: 2019
Předmět:
Adult
Male
medicine.medical_specialty
lcsh:Diseases of the musculoskeletal system
Statin
medicine.drug_class
Remission
Disease
Immune-mediated necrotizing myopathy
Autoimmune Diseases
Maintenance Chemotherapy
03 medical and health sciences
0302 clinical medicine
Refractory
Adrenal Cortex Hormones
Internal medicine
medicine
Autoimmune myositis
Humans
Myopathy
Aged
Retrospective Studies
Immunosuppressant
030203 arthritis & rheumatology
Aged
80 and over
IVIG
Myositis
Anti-HMGCR myopathy
business.industry
Immunoglobulins
Intravenous
Induction Chemotherapy
Middle Aged
Rheumatology
3. Good health
Orthopedic surgery
Cohort
Corticosteroid
Corticosteroid-free therapy
Female
Hydroxymethylglutaryl CoA Reductases
Therapy
lcsh:RC925-935
medicine.symptom
Hydroxymethylglutaryl-CoA Reductase Inhibitors
business
030217 neurology & neurosurgery
Immunosuppressive Agents
Research Article
Zdroj: Arthritis Research & Therapy
Arthritis Research & Therapy, Vol 22, Iss 1, Pp 1-10 (2020)
ISSN: 1478-6362
Popis: 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.
Databáze: OpenAIRE
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