Session Title: Muscle Biology, Myositis and Myopathies: Myositis Autoantibodies and Disease Phenotype
Session Type: Abstract Submissions (ACR)
The idiopathic inflammatory myopathies (IIM) comprise a group of autoimmune disorders that target skeletal muscle. Some IIM cases may be associated with an autoantibody against 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR), especially in statin exposed patients. The purpose of our study was to characterize the disease course, prevalence of comorbidities and detailed statin history in HMGCR antibody positive (HMGCR +) IIM patients, as compared to statin exposed HMGCR antibody negative (HMGCR -) IIM patients. We also aimed to distinguish differences between statin exposed vs statin naive HMGCR + patients.
From 5/1/02 to 1/31/14, 1687 suspected myopathy patients evaluated at the Johns Hopkins Myositis Center were enrolled in a longitudinal study. Serum and DNA samples were available for 1083 patients. Patients were included in our analysis if they met Bohan and Peter (B and P) criteria for definite/probable polymyositis or dermatomyositis. HMGCR autoantibodies were tested for via immunoprecipitation and ELISA. Patients in the comparator group were selected from the large cohort of myositis patients if they were HMGCR-, fulfilled the aforementioned B and P criteria, and had a documented statin history including exact statin name, dose, and start/stop dates. We performed a retrospective chart review from time of first clinic visit until 01/31/2014 or last clinical encounter.
There were 77 HMGCR+ patients, 19 statin naïve. Data was compared between 58 statin exposed HMGCR+ IIM patients and 39 statin exposed HMGCR- IIM patients. HMGCR+ patients were slightly older (mean age 59.9 vs 55; p=0.013) but otherwise had similar baseline characteristics. HMGCR+ patients had higher mean creatine kinase (CK) values (p<0.001), and greater hip flexor weakness at presentation (p=0.002) and over time. Distal weakness was more prevalent in HMGCR– patients (p=0.023). IVIG (p=0.036) and Rituximab (p=0.018) were used more in HMGCR+ patients. More HMGCR– patients had interstitial lung disease (ILD) (p=0.003). There was no difference in the prevalence of dysphagia. HMGCR+ patients had a higher prevalence of non-steroid induced type II diabetes (p=0.002). There was a higher prevalence of cancers in the HMGCR+ group (10 patients), although not statistically significant (p=0.775). More patients in the HMGCR+ group were exposed to atorvastatin (p<0.001). Adjusted for HMGCR antibody status, multiple regression showed no significant association between individual statins and measures of CK and proximal weakness. HMGCR- patients exposed to statins > 1 year had slightly increased arm abduction weakness at presentation. Statin naïve HMGCR+ patients were significantly younger than statin exposed HMGCR+ patients and received less Rituximab and IVIG, although results for IVIG were not statistically significant. Four statin naïve HMGCR+ patients had a history of cancer.
Compared to statin exposed HMGCR- patients, statin exposed HMGCR+ patients had a higher prevalence of type II diabetes, a high number of cancers, increased exposure to atorvastatin prior to symptom onset, less prevalence of ILD, and greater treatment with IVIG and Rituximab.
A. Lahouti H.,
A. L. Mammen,
T. E. Lloyd,
Novartis Pharmaceutical Corporation,
S. K. Danoff,
Questcor, Novartis, and Walgreen,
Inova Diagnostics, Inc.,
NUFactor, Crescent Health, and Walgreens,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/diabetes-and-atorvastatin-are-potential-risk-factors-for-statin-associated-myopathy-with-autoantibodies-against-3-hydroxy-3-methylglutaryl-coenzyme-a-reductase/