Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Patients(pts) with idiopathic inflammatory myopathies (IIM) have an increased risk of cardiovascular (CV) disease. Statins reduce CV risk but have been associated with myalgias, myositis, and rhabdomyolysis. We describe the use of statins in a longitudinal cohort of pts with IIM.
Methods: A retrospective review was conducted of 189 IIM pts (127 DM, 51 PM, 13 IBM, 3 HMGCR+ IMNM) enrolled in a longitudinal IIM cohort. All pts on statins were identified. Physician global myositis disease activity(DA) and damage(DD) assessments (100 mm visual analogue scales(VAS) and 5 point Likert scales) were performed at 3 visits: 1) visit prior to statin initiation, 2) visit immediately after statin initiation, and 3) most recent follow-up. For pts without visits prior to statin initiation, the initial study visit and two longitudinal visits were evaluated. All assessments were performed by the same myositis physician who was blinded to the statin use/non-use at the visits. Laboratory data and adverse events were gathered by chart review.
Results: 22 pts taking a statin were identified including 6 pts who were not on a statin at time of study enrollment and were started during the follow-up period. The 3 HMGCR ab+ IMNM pts in the cohort were historically on a statin but discontinued by the time of study enrollment and so not included in this analysis. Mean (SD) age was 53 (34) years and most were female (n=14, 64%). Thirteen pts had myositis antibody testing available: Ro (n=5), MDA5 (n=2), Jo1 (n=1), U1RNP(n=1), Ku(n=1) and MJ (n=1). Types of statins used included atorvastatin 10-40mg (n=12), rosuvastatin 5-20mg (n=7), simvastatin 40-80mg (n=2), pravastatin 20mg (n=2) and lovastatin 40mg (n=1). Mean (range) duration of observed statin use was 34 (0-90) months.
Among pts that were on a statin at study enrollment, 19/22 remained on a statin during the follow-up period. Of the remaining 3/22 pts: Pt #1 had a history of statin intolerance before onset of DM and remained intolerant to statins after DM diagnosis despite multiple agents tried; Pt #2 presented with rapidly progressive MDA5 + ILD, which was fatal within 1 month; Pt #3 had the statin discontinued by her primary care provider for unclear reasons (disease activity score remained low before (VAS DA=12) and after statin discontinuation (VAS DA=8) without note of intolerance). For the 6 pts started on statins during the study period, there was no worsening in disease activity measures between visit 1 (pre-statin) and visit 2 (post statin) (Table). Mean (SD) follow-up between visits 1 and 2 = 2.2(0.9) months. 3/6 IIM pts were started on a statin in the setting of active disease including cardiac muscle involvement (mean(SD) VAS DA= 49(9) n=3).
Conclusion: Statins were well tolerated in a relatively large longitudinal cohort of IIM patients. Use may be considered in IIM patients without HMGCR ab when clinically indicated for CV risk reduction.
|
Visit prior to statin initiation |
Visit after statin initiation |
|
|
CK, U/L |
450 (49-1842) |
330 (45-1369) |
|
Aldolase, U/L |
8.9 (4.6-23.3) |
7.1 (3.7-15.3) |
|
ESR, mm/hr |
33 (16-65) |
32 (9-60) |
|
CRP, mg/dL |
1.6 (<0.3-2.7) |
0.6( <0.3-1.7) |
|
Physician global Disease activity VAS(0-100) |
30 (10-58) |
24 (5-50) |
|
Likert (0-4) |
1.5 (1-2) |
1.3 (1-2) |
|
Physician global Disease damage VAS(0-100) |
47 (0-75) |
47 (0-75) |
|
Likert (0-4) |
2 (0-3) |
2 (0-3) |
To cite this abstract in AMA style:
Bae S, Golub I, Oganesian B, Charles-Schoeman C. Statin Use in a Longitudinal Cohort of Patients with Idiopathic Inflammatory Myopathies [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/statin-use-in-a-longitudinal-cohort-of-patients-with-idiopathic-inflammatory-myopathies/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/statin-use-in-a-longitudinal-cohort-of-patients-with-idiopathic-inflammatory-myopathies/