Statin-associated immune-mediated necrotizing myopathy: a retrospective analysis of individual case safety reports from VigiBase

Essers, Dirk; Schäublin, Martina; Kullak‐Ublick, Gerd A.; Weiler, Stefan

doi:10.1007/s00228-018-2589-z

Cited by 12 publications

(12 citation statements)

References 30 publications

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“…There are currently no randomised control trials to guide treatment protocols; thus recommendations are based on expert opinion from specialists experience, retrospective studies or case series. Initial treatment is usually with high-dose corticosteroids and majority of the patients require aggressive treatment with two or more immunotherapeutic agents including IVIG, methotrexate, mycophenolate mofetil, rituximab, azathioprine and occasionally plasmapheresis 1 9 11. Of note, our patient developed more severe symptoms after starting prednisone, requiring more aggressive immunosuppression.…”

Section: Discussionmentioning

confidence: 79%

“…MRI when done, shows widespread muscle oedema, with focal or diffuse abnormal signal in the trunk and limb muscles. Characteristic features on histology are myocyte necrosis and regeneration without significant inflammation 1 5 9 10. While histology is required to confirm diagnosis in the autoantibody negative NAM, specific histological features are not required to classify patients with autoantibody positive NAM 4…”

Section: Discussionmentioning

confidence: 99%

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Atypical presentation of necrotising autoimmune myopathy

Manesh

Asmi

Benjamín³

2019

BMJ Case Rep

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Necrotising autoimmune myopathy (NAM) is characterised by a common phenotype of profound symmetrical proximal muscle weakness, elevated creatine kinase levels, irritable myopathy on electromyography and histological findings of myocyte necrosis and regeneration without remarkable inflammation. NAM is associated with autoimmune antibodies including anti-3-hydroxy-3-methylglutaryl-coenzyme receptor, which is strongly associated with statin use. We report a case of statin-associated NAM with an atypical presentation of severe oropharyngeal dysphagia and no remarkable proximal muscle weakness at initial presentation but with rapid progression to severe quadriparesis in weeks. This case expands the spectrum of presentation patterns of this rare disease and highlights the need for a high index of suspicion in patients with a remote history of statin use.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Atypical presentation of necrotising autoimmune myopathy

Manesh

Asmi

Benjamín³

2019

BMJ Case Rep

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“…A review of recent literature yielded only two reported cases with death as a complication of statininduced IMNM. 13 Of these two cases, one described dysphagia as a presenting symptom. Interestingly, this case was also complicated by respiratory distress requiring ventilator support, and ultimately death from ventilator-acquired pneumonia.…”

Section: Discussionmentioning

confidence: 99%

“… 7 With commercially available antibody testing now more readily available, biopsy is no longer required for a diagnosis of seropositive IMNM. 13 However, seronegative IMNM accounts for 25-40% of IMNM, and presents with elevated CPK, muscle weakness, and a biopsy demonstrating necrotizing myopathy despite no antibody detection. Hence, muscle biopsy remains necessary for a diagnosis of seronegative IMNM, and for this reason is still often employed as part of the diagnostic work up.…”

Section: Discussionmentioning

confidence: 99%

Immune Mediated Necrotizing Myopathy: A Rare Complication of Statin Therapy

Abusharar

Moku

Banks

et al. 2020

Clinics and Practice

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Immune mediated necrotizing myopathy (IMNM) is part of the inflammatory myopathies group of diseases and presents with muscle weakness, myalgias and elevated serum creatine phosphokinase (CPK). Statin-induced IMNM is a rare complication. We present a patient with IMNM secondary to simvastatin use. The patient presented with proximal myopathy, dysphagia, and elevated creatinine kinase levels, and was subsequently found to have anti-3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) autoantibodies with a necrotizing process on muscle biopsy. This patient’s case was further complicated by sequelae of multiple disease processes, ultimately leading to deterioration of his health.

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“…Its onset can be days to years after continuous exposure to statins 4. Most of the cases have been reported with atorvastatin, but no data on certain statins or dose dependency have been found 5. Pathogenesis of SINAM is still not completely understood, but an association has been observed between statin exposure and autoantibodies against HMGCR.…”

Section: Discussionmentioning

confidence: 99%

Statin-induced necrotising autoimmune myopathy and autoimmune hepatitis presenting with dysphagia

2020

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Statin-induced necrotising autoimmune myopathy (SINAM) is a rare disease characterised by proximal muscle weakness and elevated creatine kinase levels that is usually in the thousands. Anti-3-hydroxy-3-methyl glutaryl co-enzyme A reductase (HMGCR) antibodies are associated with SINAM. Autoimmune hepatitis (AIH) is an inflammatory disease of the liver that is usually of unknown aetiology but can also be associated with concurrent extrahepatic autoimmune disorders. We are reporting a case of biopsy proven AIH associated with SINAM in a patient presenting with oropharyngeal dysphagia. The patient had elevated anti-HMGCR antibodies and anti-smooth muscle antibodies. SINAM and AIH were confirmed by muscle biopsy and liver biopsy, respectively. The patient had complete resolution of his symptoms and complete normalisation of his liver function tests after 6 months of the treatment.

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Statin-associated immune-mediated necrotizing myopathy: a retrospective analysis of individual case safety reports from VigiBase

Cited by 12 publications

References 30 publications

Atypical presentation of necrotising autoimmune myopathy

Atypical presentation of necrotising autoimmune myopathy

Immune Mediated Necrotizing Myopathy: A Rare Complication of Statin Therapy

Statin-induced necrotising autoimmune myopathy and autoimmune hepatitis presenting with dysphagia

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