Rarity of anti–3-hydroxy-3-methylglutaryl-coenzyme A reductase antibodies in statin users, including those with self-limited musculoskeletal side effects

Authors

  • Andrew L. Mammen,

    Corresponding author
    1. Johns Hopkins University, Baltimore, Maryland
    • Johns Hopkins Bayview Medical Center, Johns Hopkins Myositis Center, Mason F. Lord Building Center Tower, Suite 4100, Baltimore, MD 21224
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    • Dr. Mammen has a provisional patent on an anti–3- hydroxy-3-methylglutaryl-coenzyme A assay; this has not been licensed.

  • Katherine Pak,

    1. Johns Hopkins University, Baltimore, Maryland
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  • Emma K. Williams,

    1. Johns Hopkins University, Baltimore, Maryland
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  • Diane Brisson,

    1. University of Montreal, Montreal, and Chicoutimi Hospital, Saguenay, Quebec, Canada
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  • Joe Coresh,

    1. Johns Hopkins University, Baltimore, Maryland
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    • Dr. Coresh has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Amgen International and Merck.

  • Elizabeth Selvin,

    1. Johns Hopkins University, Baltimore, Maryland
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    • Drs. Selvin and Gaudet contributed equally to this work.

  • Daniel Gaudet

    1. University of Montreal, Montreal, and Chicoutimi Hospital, Saguenay, Quebec, Canada
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    • Drs. Selvin and Gaudet contributed equally to this work.

    • Dr. Gaudet is chair holder of the Canada Research Chair in preventive genetics and community genomics.


Abstract

Objective

Statins, among the most commonly prescribed medications, are associated with a wide range of musculoskeletal side effects. These include a progressive autoimmune myopathy with anti–3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibodies that requires immunosuppression. However, it remains unknown whether these antibodies are found in statin users with and without self-limited musculoskeletal side effects; this limits their diagnostic utility. The current work assessed the prevalence of anti-HMGCR antibodies in these groups of statin users.

Methods

We determined the prevalence of anti-HMGCR antibodies in 1,966 participants (including 763 current statin users) in a substudy of the community-based Atherosclerosis Risk in Communities (ARIC) Study and 98 French Canadian subjects with familial hypercholesterolemia, including 51 with documented statin intolerance.

Results

No participant in the ARIC substudy, including those with past or current statin exposure at the time of sample collection, had anti-HMGCR antibodies. Similarly, none of 51 patients with self-limited statin intolerance or 47 statin-tolerant patients receiving maximal statin therapy were anti-HMGCR positive.

Conclusion

The majority of patients with and without statin exposure, including those with self-limited statin intolerance, do not develop anti-HMGCR antibodies. Therefore, anti-HMGCR antibodies are highly specific for those with an autoimmune myopathy.

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