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Statin-Induced Myopathy

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1. Should patients on statins take Coenzyme Q10 supplementation to reduce the risk of statin-induced myopathy?

Should patients on statins take Coenzyme Q10 supplementation to reduce the risk of statin-induced myopathy? Should patients on statins take Coenzyme Q10 supplementation to reduce the risk of statin-induced myopathy? – SPS - Specialist Pharmacy Service – The first stop for professional medicines advice Menu · · 28th March 2019 · UKMi This updated Medicines Q&A evaluates the available evidence on the use of coenzyme Q10 supplementation to reduce the risk of statin-induced myopathy. There is some (...) limited evidence which suggests that CoQ10 supplementation with statin treatment may improve statin-associated muscle symptoms. However, CoQ10 supplementation does not appear to have any effect on CK levels though data on this are also limited. More information is needed about the cause of statin-induced myopathy including about how exogenous CoQ10 affects endogenous tissue levels and whether restoring these levels results in a clinical reduction of muscle symptoms. Most importantly, studies which

2019 Specialist Pharmacy Services

3. When Should a Patient with Statin-Induced Myopathy Be Re-challenged? A Case of Necrotizing Autoimmune Myopathy (PubMed)

When Should a Patient with Statin-Induced Myopathy Be Re-challenged? A Case of Necrotizing Autoimmune Myopathy Statins are notorious for causing myalgia and sometimes mild elevation of CPK (creatine phosphokinase). Herein, we present a case of necrotizing autoimmune myopathy induced by statins. The patient was on therapy with atorvastatin for about six years before she started developing myalgia and mild elevation in CPK that resolved after discontinuation of therapy. Since her cardiovascular (...) risk was high and she had hypercholesterolemia, three months after CPK levels normalization, she was re-challenged with pravastatin. Few months later, she again presented severe myalgia, weakness, and elevated CPK levels. Hence, medication was discontinued, and she undergone an extensive workup for possible causes of inflammatory myopathies that revealed necrotizing autoimmune myopathy. Our case report offers an excellent source of "identification patterns" of muscular autoimmune disease which can

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2018 Case reports in rheumatology

4. Economic Evaluation of a Pharmacogenomics Test for Statin-Induced Myopathy in Cardiovascular High-Risk Patients Initiating a Statin (PubMed)

Economic Evaluation of a Pharmacogenomics Test for Statin-Induced Myopathy in Cardiovascular High-Risk Patients Initiating a Statin Statins are the mainstay hypercholesterolemia treatment and reduce the risk of cardiovascular events in patients. However, statin therapy is often interrupted in patients experiencing musculoskeletal pain or myopathy, which are common in this patient group. Currently, the standard tests for diagnosing statin myopathies are difficult to interpret. A pharmacogenomics (...) (PGx) test to diagnose statin-induced myopathy would be highly desirable.We developed a Markov state model to assess the cost-effectiveness of a hypothetical PGx test, which aims to identify statin-induced myopathy in high-risk, secondary prevention cardiovascular patients. The alternative strategy hypothesized is that physicians or patients interrupt the statin therapy in the presence of musculoskeletal pain. Our model includes health states specific to the PGx test outcome which assesses

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2016 Molecular diagnosis & therapy

5. Application of the Statin-Associated Muscle Symptoms-Clinical Index to a Randomized Trial on Statin Myopathy. (PubMed)

Application of the Statin-Associated Muscle Symptoms-Clinical Index to a Randomized Trial on Statin Myopathy. 28935043 2017 09 22 1558-3597 70 13 2017 Sep 26 Journal of the American College of Cardiology J. Am. Coll. Cardiol. Application of the Statin-Associated Muscle Symptoms-Clinical Index to a Randomized Trial on Statin Myopathy. 1680-1681 S0735-1097(17)39054-X 10.1016/j.jacc.2017.07.767 Taylor Beth A BA Sanchez Robert J RJ Jacobson Terry A TA Chibedi-De-Roche Daniela D Manvelian Garen G

2017 Journal of the American College of Cardiology

6. Primary Care Corner with Geoffrey Modest MD: Statin myopathy and vitamin D deficiency

Primary Care Corner with Geoffrey Modest MD: Statin myopathy and vitamin D deficiency Primary Care Corner with Geoffrey Modest MD: Statin myopathy and vitamin D deficiency | BMJ EBM Spotlight by by Dr Geoffrey Modest A recent editorial provided reasonably convincing evidence that there is a relationship between low vitamin D levels and statin associated muscle symptoms, SAMS (see Glueck CJ. Atherosclerosis. 2017; 256: 125). See article for the references. Details/summary of data: — one study (...) . — Myopathy is also a reasonably common symptom of vitamin D deficiency — there are which suggest that even those with intolerable muscle symptoms from 3 or more statins, only 43% had muscle symptoms on rechallenge (and 27% had muscle symptoms only on placebo, 17% had symptoms to neither drug). ie, there is likely a pretty big placebo effect. Though the 90+% success rates with vitamin D noted above are a bit eye-popping. — so, a provocative editorial. Clearly, especially in light of the potentially large

2017 Evidence-Based Medicine blog

7. Statin-Associated Autoimmune Myopathy

Statin-Associated Autoimmune Myopathy Rotation Prep | NEJM Resident 360 Social Login Email Login Log in via Email Create Your Account We will not share your email with anyone. Password must be at least 8 characters. Show or Hide the password you are typing. Request to Join has invited you to join this group Your browser does not support video tags Welcome! NEJM Resident 360 helps you prepare for your next rotation quickly and efficiently, provides support for coping with the pressures

2016 Now@NEJM

8. Statin-induced Anti-HMGCR-associated Myopathy (PubMed)

Statin-induced Anti-HMGCR-associated Myopathy 27386780 2018 08 08 2018 11 13 1558-3597 68 2 2016 07 12 Journal of the American College of Cardiology J. Am. Coll. Cardiol. Statin-Induced Anti-HMGCR-Associated Myopathy. 234-5 10.1016/j.jacc.2016.04.037 S0735-1097(16)33004-2 Basharat Pari P Lahouti Arash H AH Paik Julie J JJ Albayda Jemima J Pinal-Fernandez Iago I Bichile Tanmayee T Lloyd Thomas E TE Danoff Sonye K SK Casciola-Rosen Livia L Mammen Andrew L AL Christopher-Stine Lisa L eng P30 (...) induced immunology 2015 11 25 2016 04 07 2016 04 12 2016 7 9 6 0 2016 7 9 6 0 2018 8 9 6 0 ppublish 27386780 S0735-1097(16)33004-2 10.1016/j.jacc.2016.04.037 PMC5640444 NIHMS907944 N Engl J Med. 1975 Feb 13;292(7):344-7 1090839 Arthritis Rheum. 2012 Dec;64(12):4087-93 22933019 N Engl J Med. 1975 Feb 20;292(8):403-7 1089199 Arthritis Rheum. 2011 Mar;63(3):713-21 21360500 Arthritis Rheum. 2010 Sep;62(9):2757-66 20496415

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2016 Journal of the American College of Cardiology

9. Statin-induced myopathy in a usual care setting—a prospective observational study of gender differences (PubMed)

Statin-induced myopathy in a usual care setting—a prospective observational study of gender differences The study aims to identify the occurrence and remission of statin-induced myopathy including patient perception and symptom characteristics with a gender perspective.The study was designed as a prospective, non-interventional investigation in 192 outpatients receiving statin treatment in usual care with 12 months follow-up. Main outcome measure was myopathy related to statin treatment (...) with myopathy were more susceptible to other statin-induced ADRs which raises the question about common underlying mechanisms.

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2016 European journal of clinical pharmacology

10. GATM polymorphism associated with the risk for statin-induced myopathy does not replicate in case-control analysis of 715 dyslipidemic individuals.

GATM polymorphism associated with the risk for statin-induced myopathy does not replicate in case-control analysis of 715 dyslipidemic individuals. Statin-induced myopathy (SIM) is the most common reason for discontinuation of statin therapy. A polymorphism affecting the gene encoding glycine amidinotransferase (GATM rs9806699 G > A) was previously associated with reduced risk for SIM. Our objective was to replicate the GATM association in a large, multicenter SIM case-control study. Mild

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2016 Cell metabolism

11. Statin-Induced Myopathy

Statin-Induced Myopathy Statin-Induced Myopathy Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Statin-Induced Myopathy Statin-Induced (...) Myopathy Aka: Statin-Induced Myopathy , Rhabdomyolysis due to Statin , Statin-Induced Myalgias , Myositis due to Statins , Statin Myopathy From Related Chapters II. Epidemiology Statin-Induced Myalgias are common (5-30%) -induced is very uncommon (<0.01%) III. Mechanism Typical Muscle injury secondary to use (drug-induced - accelerating muscle cell death) -Induced Immune-mediated Necrotizing Newly defined in 2011 Symptoms and findings (including CPK) remain abnormal after stopping the IV. Symptoms

2018 FP Notebook

12. Impact of vitamin D status on statin-induced myopathy (PubMed)

Impact of vitamin D status on statin-induced myopathy There is a multitude of evidence supporting the benefit of statin use in cardiovascular disease; however, statin-induced myopathy is a major reason for statin discontinuation and non-adherence. Vitamin D deficiency has been independently associated with muscle weakness and severe myopathy, and may be a confounder for statin-induced myopathies. Since there is no consensus on a treatment course of action for statin-induced myopathy (...) , investigation into potential confounders to elucidate the dynamics of statin-induced myopathy is warranted.A retrospective chart review was conducted on 105 patients in a cardiometabolic clinic with a vitamin D drawn from December 2006 to April 2008. Patients exposed to statins were divided into two groups: (1) patients with low vitamin D (<32 ng/mL) [n = 52] and (2) patients with a sufficient vitamin D level (⩾32 ng/mL) [n = 32]. Data were compared via t-tests or Fisher's Exact, as appropriate.There were

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2016 Journal of clinical & translational endocrinology

13. Statin Coadministration Increases the Risk of Daptomycin-Associated Myopathy. (PubMed)

Statin Coadministration Increases the Risk of Daptomycin-Associated Myopathy. Daptomycin-associated myopathy has been identified in 2%-14% of patients, and rhabdomyolysis is a known adverse effect. Although risk factors for daptomycin-associated myopathy are poorly defined, creatine phosphokinase (CPK) monitoring and temporary discontinuation of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or "statins," has been recommended.We conducted a single-center, retrospective, matched (...) times the upper limit of normal.Of 3042 patients reviewed, 128 (4.2%) were identified as having daptomycin-associated myopathy, 25 (0.8%) of whom had rhabdomyolysis; 121 (95%) of the 128 were adults, and the mean duration of therapy before CPK elevation was 16.7 days (range, 1-58 days). In multivariate analysis, deep abscess treatment (odds ratio, 2.80; P = .03), antihistamine coadministration (3.50; P = .03), and statin coadministration (2.60; P = .03) were independent risk factors for myopathy

2018 Clinical Infectious Diseases

14. Myopathy due to HMGCR antibodies in adult mimicking muscular dystrophy associated with cancer and statin exposure – narrative review of the literature – case report (PubMed)

Myopathy due to HMGCR antibodies in adult mimicking muscular dystrophy associated with cancer and statin exposure – narrative review of the literature – case report Necrotizing autoimmune myopathy is characterized by predominant muscle fiber necrosis and regeneration with little or no inflammation. We describe a 58-year-old woman with previous breast cancer and statin use who complained of rapidly progressive weakness of lower limbs without pain, making walking, running and climbing stairs (...) difficult. The creatine kinase level was 2,843 U/L, and muscle biopsy showed a dystrophic pattern. The genetic test for muscular dystrophies was negative and for anti-3-hydroxy-3-methylglutaryl coenzyme A reductase was positive. Intravenous immunoglobulin was administered, which showed mild improvement. Unfortunately, she took a step and collapsed to the floor, which led to the fracture of right femur delaying her improvement. The diagnosis of necrotizing autoimmune myopathy is sometimes delayed due

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2018 Therapeutics and clinical risk management

15. Assessment of the Risk of Rhabdomyolysis and Myopathy During Concomitant Treatment with Ticagrelor and Statins (PubMed)

Assessment of the Risk of Rhabdomyolysis and Myopathy During Concomitant Treatment with Ticagrelor and Statins The introduction of ticagrelor, one of the first directly-acting oral antiplatelet drugs, provided new possibilities in the prevention of thrombotic events in patients with acute coronary syndromes (ACS). Current guidelines recommend ticagrelor in dual antiplatelet therapy with aspirin over clopidogrel for prevention of stent thrombosis in patients with ACS. Moreover, in the management (...) of ACS, lipid-lowering treatment with high-intensity statin therapy is advised for secondary prevention of cardiovascular events over the long term. Despite the apparent advantages of combined antiplatelet and lipid-lowering treatments, a possible interaction between statins and ticagrelor may lead to myopathy and rhabdomyolysis. In this review, relevant information was gathered on the ticagrelor-statin interaction that might lead to this life-threatening condition. This review focuses on the most

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2018 Drugs

16. Statin-Associated Autoimmune Myopathy. (PubMed)

Statin-Associated Autoimmune Myopathy. 26886523 2016 03 01 2016 02 18 1533-4406 374 7 2016 Feb 18 The New England journal of medicine N. Engl. J. Med. Statin-Associated Autoimmune Myopathy. 664-9 10.1056/NEJMra1515161 Mammen Andrew L AL eng Journal Article Review United States N Engl J Med 0255562 0028-4793 0 Glucocorticoids 0 Hydroxymethylglutaryl-CoA Reductase Inhibitors VB0R961HZT Prednisone AIM IM Algorithms Autoimmune Diseases chemically induced drug therapy Glucocorticoids therapeutic use (...) Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors adverse effects Muscle, Skeletal pathology Muscular Diseases chemically induced drug therapy immunology pathology Prednisone therapeutic use 2016 2 18 6 0 2016 2 18 6 0 2016 3 2 6 0 ppublish 26886523 10.1056/NEJMra1515161

2016 NEJM

17. Risk of Colchicine-Associated Myopathy in Gout: Influence of Concomitant Use of Statin. (PubMed)

Risk of Colchicine-Associated Myopathy in Gout: Influence of Concomitant Use of Statin. The purpose of this study was to investigate the risk of myopathy when statins are coadministered with colchicine in patients with gout.In gout patients who received colchicine with or without statin, clinical data collected included medications and history of hypertension, chronic kidney disease, and liver cirrhosis. Myopathy was defined as the presence of muscle symptoms with elevated creatine kinase (...) or myoglobin. Multivariate analysis was performed to identify risk factors for myopathy. Inverse probability of treatment weighting (IPTW)-adjusted analysis was used to evaluate the influence of concomitant colchicine and statin use on myopathy.Of 674 patients, 486 received colchicine alone and 188 also received statin. The incidence of myopathy was not significantly higher in those on both drugs than in those on colchicine alone (2.7% vs 1.4%, P = .330). On multivariate analysis, chronic kidney disease

2017 American Journal of Medicine

18. Immune-mediated necrotizing myopathy associated with statins: history and recent developments. (PubMed)

Immune-mediated necrotizing myopathy associated with statins: history and recent developments. The use of statins has increased exponentially over the last 2 decades. Consequently, side effects have also increased, with muscle-related side effects commonly reported.Although once thought to be only associated with self-limited direct myotoxicity, statins have recently been described in association with an autoimmune myopathy in association with antibodies directed against 3-hydroxy-3 (...) -methylglutaryl-CoA reductase (HMGCR), the rate limiting enzyme in cholesterol synthesis and the pharmacologic target of statins. Since this discovery, various cohorts have been identified worldwide and highlight both similarities and differences among them.Recent studies from different fields have revealed diverse aspects of anti-HMGCR-associated immune-mediated necrotizing myopathy (IMNM). HMGCR IMNM is a unique autoimmune disease characterized by a well defined environmental trigger (statins) and a strong

2017 Current Opinion in Rheumatology

19. Statin-associated immune-mediated myopathy: biology and clinical implications. (PubMed)

Statin-associated immune-mediated myopathy: biology and clinical implications. In the last 6 years, our understanding of statin-associated myopathy expanded to include not only a toxic myopathy with limited and reversible side-effects but also an autoimmune variety in which statins likely induce an autoimmune myopathy that is both associated with a specific autoantibody and responsive to immunosuppression and immune modulation. This review widens the reader's understanding of statin myopathy (...) to include an autoimmune process.Statin-associated immune-mediated myopathy provides an example of an environmental trigger (statins) directly implicated in an autoimmune disease associated with a genetic predisposition as well as potential risk factors including concomitant diseases and specific statins. Given a median exposure to statins of 38 months, providers should be aware that anti-3-hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMGCR) myopathy may occur even after several years of statin

2017 Current Opinion in Lipidology

20. The Impact of Exercise on Statin-Associated Skeletal Muscle Myopathy. (PubMed)

exercise can influence statin-induced myopathy in hypercholesterolemic (ApoE-/-) mice. Mice either received daily injections of saline or simvastatin (20 mg/kg) while: 1) remaining sedentary (Sed), 2) engaging in daily exercise for two weeks (novel, Nov), or 3) engaging in daily exercise for two weeks after a brief period of training (accustomed, Acct) (2x3 design, n = 60). Cholesterol, activity, strength, and indices of myofiber damage and atrophy were assessed. Running wheel activity declined in both (...) , yet enhanced fiber damage or atrophy was not observed. The results from this study suggest that exercise (Nov, Acct) does not exacerbate statin-induced myopathy in ApoE-/- mice, yet statin treatment reduces activity in a manner that prevents muscle from mounting a beneficial adaptive response to training.

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2016 PLoS ONE

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