Anti-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibody in necrotizing myopathy: treatment outcomes, cancer risk, and role of autoantibody level

Aggarwal, Rohit; Moghadam-Kia, Siamak; Lacomis, David; Malik, Asma; Qi, Zengbiao; Koontz, Diane; Burlingame, Rufus W.; Oddis, Chester V.

doi:10.1080/03009742.2019.1672782

Cited by 24 publications

(21 citation statements)

References 23 publications

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“…Positivity for other autoantibodies, including anti-3-hydroxy 3-methylutaryl coenzyme A reductase (anti-HMGCR) [ 21 , 62 , 71 , 80 , 81 ], anti-signal recognition particle (anti-SRP) [ 62 , 71 , 80 ], anti-small ubiquitin-like modifier-1 activating enzyme (anti-SAE1) [ 21 , 62 , 71 ], anti-melanoma differentiation-associated gene 5 (anti-MDA5) [ 21 , 44 , 48 , 62 , 71 ] or anti-Mi2 [ 21 , 41 , 58 , 62 , 64 , 71 ], were identified as non-significant factors for cancer. Both myositis specific autoantibody (MSA) negativity [ 21 , 30 , 45 , 62 , 71 ] and ANA positivity [ 22 , 26 , 28 , 30 , 39 , 41 , 43 , 46 , 50 , 53 , 54 , 56 , 82 ] were non-significant factors.…”

Section: Resultsmentioning

confidence: 99%

A systematic review and meta-analysis to inform cancer screening guidelines in idiopathic inflammatory myopathies

et al. 2021

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Objectives To identify clinical factors associated with cancer risk in the idiopathic inflammatory myopathies (IIMs) and to systematically review the existing evidence related to cancer screening. Methods A systematic literature search was carried out on Medline, Embase and Scopus. Cancer risk within the IIM population (i.e. not compared to the general population) was expressed as risk ratios (RR) for binary variables and weighted mean differences (WMD) for continuous variables. Evidence relating to cancer screening practices in the IIMs were synthesised via narrative review. Results Sixty nine studies were included in the meta-analysis. Dermatomyositis subtype (RR 2.21), older age (WMD 11.19), male gender (RR 1.53), dysphagia (RR 2.09), cutaneous ulceration (RR 2.73), and anti-transcriptional intermediary factor-1 gamma positivity (RR 4.66) were identified as being associated with significantly increased risk of cancer. Polymyositis (RR 0.49) and clinically amyopathic dermatomyositis (RR 0.44) subtypes, Raynaud’s phenomenon (RR 0.61), interstitial lung disease (RR 0.49), very high serum creatine kinase (WMD -1189.96) or lactate dehydrogenase (WMD -336.52) levels, and anti-Jo1 (RR 0.45) or anti-EJ (RR 0.17) positivity were identified as being associated with significantly reduced risk of cancer. Nine studies relating to IIM-specific cancer screening were included. Computed tomography (CT) scanning of the thorax, abdomen and pelvis appeared to be effective in identifying underlying asymptomatic cancers. Discussion Cancer risk factors should be evaluated in patients with IIM for risk stratification. Screening evidence is limited but CT scanning could be useful. Prospective studies and consensus guidelines are needed to establish cancer screening strategies in IIM patients.

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Section: Resultsmentioning

confidence: 99%

A systematic review and meta-analysis to inform cancer screening guidelines in idiopathic inflammatory myopathies

et al. 2021

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“…Common immunosuppressive that have been shown to be effective are corticosteroids, i n t r a v e n o u s i m m u n o g l o b u l i n ( I V I G ) , A Z A , methotrexate (MTX), and mycophenolate mofetil (5,9,10). MTX or IVIG have been used for refractory cases, with both resulting in improvement (3,(10)(11)(12). The postulated mechanism for anti-HMGCR myopathy includes autoimmunity against HMGCR; since B cells play a big role in autoantibody production, B cell depletion would appear to be an effective treatment strategy for the condition (2).…”

Section: Discussionmentioning

confidence: 99%

Rituximab use for refractory anti-HMGCR immune-mediated necrotizing myopathy: A case report

Gupta

Rakhra

Thallapally

et al. 2021

IRDR

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anti-HMGCR, immune-mediated necrotizing myopathy, immunosuppressants, rituximab Immunosuppression is the cornerstone therapy for anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) myopathy. Typical immunosuppressants such as corticosteroids, methotrexate, and azathioprine have been used in conjunction with removal of the offending agent, yet the use of rituximab is more limited in this type of myopathy. Reported here is a case of a patient who responded well to rituximab (RTX) after the standard immunosuppressants had failed. This case illustrates the importance of further studies to evaluate the role of RTX in anti-HMGCR myopathy.

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“…Moreover, anti-TIF1γ serum titre correlated with myositis activity and, more importantly, with the presence of metastatic or recurrent malignancy (98,99). Of note, anti-HMGCR was retrieved in about 48% of patients previously diagnosed as MSA-negative IMNM and was associated with statin exposure, severe muscle weakness, high CK levels, paucity of extramuscular manifestations and good response to treatment (100). Conversely, anti-SRP IMNM may be refractory to steroid therapy in A steroid-free regimen as induction therapy for statin related anti-HMGCR myositis was successful in 14 patients with CPK elevation and normal strength, whereas a regimen of IVIg/ GCs/steroid-sparing immunosuppressants was effective in 73% of patients with proximal weakness and should be initiated as soon as possible in order to achieve GCs-free maintenance (117).…”

Section: Laboratory Investigations and Autoantibodiesmentioning

confidence: 93%

Idiopathic inflammatory myopathies: one year in review 2021

Cardelli

Zanframundo

Cometi

et al. 2022

Clinical and Experimental Rheumatology

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Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of rare and complex connective tissue diseases, mainly characterised by inflammatory involvement of skeletal muscles. Several other organs may be affected, particularly lungs, heart, skin, gastrointestinal tract and joints, often determining the morbidity and mortality associated with these autoimmune disorders. The course is generally chronic and the onset subacute. This latter aspect, together with the rarity of these conditions, can result in a clinical challenge for the physician with a considerable diagnostic delay. The scientific literature makes continuous advances in the understanding of these diseases, in particular with regards to the pathogenesis, serological findings, diagnostic strategies and therapeutic approaches. The aim of this review is to highlight the most relevant literature contributions published on this topic over the last year.

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Anti-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) antibody in necrotizing myopathy: treatment outcomes, cancer risk, and role of autoantibody level

Cited by 24 publications

References 23 publications

A systematic review and meta-analysis to inform cancer screening guidelines in idiopathic inflammatory myopathies

A systematic review and meta-analysis to inform cancer screening guidelines in idiopathic inflammatory myopathies

Rituximab use for refractory anti-HMGCR immune-mediated necrotizing myopathy: A case report

Idiopathic inflammatory myopathies: one year in review 2021

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