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Statin-associated autoimmune myopathy and anti-HMGCR autoantibodies

Authors

  • Payam Mohassel MD,

    1. Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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  • Andrew L. Mammen MD, PhD

    Corresponding author
    1. Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
    2. Department of Medicine, The Johns Hopkins Bayview Medical Center, Myositis Center, Mason F. Lord Building Center Tower, Baltimore, Maryland, USA
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  • Disclosure: A.L.M. holds a patent for anti-HMGCR antibody testing.

  • This work was supported by the National Institutes of Health (K08-AR-054783 to A.L.M.).

ABSTRACT

Statins are among the most commonly prescribed medications that significantly reduce cardiovascular risk in selected individuals. However, these drugs can also be associated with muscle symptoms ranging from mild myalgias to severe rhabdomyolysis. Although statin myotoxicity is usually self-limited, in some instances statin-exposed subjects can develop an autoimmune myopathy typically characterized by progressive weakness, muscle enzyme elevations, a necrotizing myopathy on muscle biopsy, and autoantibodies that recognize 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR), the pharmacologic target of statins. These antibodies are also found in some autoimmune myopathy patients without statin exposure. Importantly, anti-HMGCR antibodies are not found in the vast majority of statin-exposed subjects without autoimmune myopathy, including those with self-limited statin intolerance. Thus, testing for these antibodies may help differentiate those with self-limited statin myopathy who recover after statin discontinuation from those with a progressive statin-associated autoimmune myopathy who typically require immunosuppressive therapy. Muscle Nerve 48: 477–483, 2013

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