Statin-associated myasthenia: A case report and literature review

Gras‐Champel, Valérie; Masmoudi, Inès; Batteux, Benjamin; Merle, P; Liabeuf, Sophie; Masmoudi, Kamel

doi:10.1016/j.therap.2019.07.004

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…However, statins are not exempt from severe adverse events; cases have been reported of rhabdomyolysis, 15 lupus‐like syndrome, 16 autoimmune diseases, 17 neuromuscular diseases, pancreatitis, and hepatitis, 18 ; however, even though the list is vast, the benefits overweight the adverse events 19,20 …”

Section: Discussionmentioning

confidence: 99%

“…Statins have many other uses thanks to their antiinflammatory and immunomodulatory effects, pleiotropic effects (improvement of cardiovascular function, antifibrotic effects, broad antioxidant, and anti-inflammatory effects, enhancement of bone formation, and neuro-and renal-protective effects), [6][7][8][9][10][11] reasons of which have been used in autoimmune disorders 12,13 and cancer diseases. 14 However, statins are not exempt from severe adverse events; cases have been reported of rhabdomyolysis, 15 lupus-like syndrome, 16 autoimmune diseases, 17 neuromuscular diseases, pancreatitis, and hepatitis, 18 ; however, even though the list is vast, the benefits overweight the adverse events. 19,20 Crestor has been associated with skin reactions <0.01%, 19 to our best knowledge, and after extensive literature review, this is the first case of leukocytoclastic vasculitis induced by Atorvastatin ANCA negative.…”

Section: Discussionmentioning

confidence: 99%

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A rare adverse event of atorvastatin inducing leukocytoclastic vasculitis with ANCA‐negative (Anti‐Neutrophil cytoplasmic antibody) case report and literature review

Guevara

Flores‐Chang

Chilakala

et al. 2023

Clinical Case Reports

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Leukocytoclastic vasculitis is an entity associated with drugs, infections, cryoglobulinemia, and connective tissue diseases but can also be idiopathic, systemic, or organ localized. Moreover, LCV associated with drugs is a rare disorder. When it is present usually has an elevation of anti‐neutrophil cytoplasmic antibody, most likely anti‐myeloperoxidase, which can be helpful to orient the diagnosis. We are presenting a 55‐year‐old female with a past medical history of diabetes mellitus (DM) and hyperlipidemia (HLD) who presented with a painful and pruritic rash localized in the abdomen and lower extremities that started 1 week after initiated atorvastatin for management of hyperlipidemia. This is the first case ever reported of leukocytoclastic vasculitis ANCA negative associated with atorvastatin, to our best knowledge.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A rare adverse event of atorvastatin inducing leukocytoclastic vasculitis with ANCA‐negative (Anti‐Neutrophil cytoplasmic antibody) case report and literature review

Guevara

Flores‐Chang

Chilakala

et al. 2023

Clinical Case Reports

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“…Autoimmune necrotizing myositis [10][11][12]138] is a feared complication of statin use. (Other autoimmune complications of statins are also reported [139][140][141][142][143]-which can affect muscle [144][145][146][147]-and in some cases, these accompany autoimmune myositis [13][14][15][16]148].) Autoimmunity is also a complication of COVID-19 [149][150][151][152] (encompassing, specifically, autoimmune conditions reported with statins [6,7,[153][154][155] including necrotizing myositis [8,9]) and is a factor in long-COVID [156][157][158][159]: in one "multi-omics" study of long-COVID, an autoimmune profile represented one of the four key patterns observed [160].…”

Section: Skeletal Muscle (Airway Dilator Muscles and Muscles Of Respi...mentioning

confidence: 98%

Statin Use in Relation to COVID-19 and Other Respiratory Infections: Muscle and Other Considerations

Golomb

Han

Langsjoen³

et al. 2023

JCM

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Statins have been widely advocated for use in COVID-19 based on large favorable observational associations buttressed by theoretical expected benefits. However, past favorable associations of statins to pre-COVID-19 infection outcomes (also buttressed by theoretical benefits) were unsupported in meta-analysis of RCTs, RR = 1.00. Initial RCTs in COVID-19 appear to follow this trajectory. Healthy-user/tolerator effects and indication bias may explain these disparities. Moreover, cholesterol drops in proportion to infection severity, so less severely affected individuals may be selected for statin use, contributing to apparent favorable statin associations to outcomes. Cholesterol transports fat-soluble antioxidants and immune-protective vitamins. Statins impair mitochondrial function in those most reliant on coenzyme Q10 (a mevalonate pathway product also transported on cholesterol)—i.e., those with existing mitochondrial compromise, whom data suggest bear increased risks from both COVID-19 and from statins. Thus, statin risks of adverse outcomes are amplified in those patients at risk of poor COVID-19 outcomes—i.e., those in whom adjunctive statin therapy may most likely be given. High reported rates of rhabdomyolysis in hospitalized COVID-19 patients underscore the notion that statin-related risks as well as benefits must be considered. Advocacy for statins in COVID-19 should be suspended pending clear evidence of RCT benefits, with careful attention to risk modifiers.

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“…Starting in 2000, a series of case reports drew attention to the possibility of statininduced myasthenic syndrome [99,104] or worsening of preexisting MG after statin exposure [105]. Patients with statin-induced MG were either sero-positive or-negative for acetylcholine receptor antibodies [106], but symptoms improved after statin cessation and/or immunosuppressive therapy [107] and, in some cases, reemerged after statin rechallenge [105]. In fact, by accessing the World Health Organization's international database of suspected adverse drug reactions (VigiBase ® ), Gras-Champel et al identified a 2.66-fold greater odds ratio for statins in relation to the reporting of MG [103,108].…”

Section: Statins In Myasthenia Gravismentioning

confidence: 99%

Cholesterol Management in Neurology: Time for Revised Strategies?

Andronie‐Cioara

Jurcău

et al. 2022

JPM

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Statin therapy has been extensively evaluated and shown to reduce the incidence of new or recurrent vascular events, ischemic stroke included. As a consequence, each published guideline pushes for lower low-density cholesterol levels in the population at large, recommending increased statin doses and/or adding new cholesterol-lowering molecules. Neurologists find it sometimes difficult to apply these guidelines, having to confront situations such as (1) ischemic strokes, mainly cardioembolic ones, in patients with already low LDL-cholesterol levels; (2) myasthenic patients, whose lifespan has been extended by available treatment, and whose age and cholesterol levels put them at risk for ischemic stroke; (3) patients with myotonic dystrophy, whose disease often associates diabetes mellitus and heart conduction defects, and in whom blood cholesterol management is also not settled. As such, further trials are needed to address these issues.

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Statin-associated myasthenia: A case report and literature review

Cited by 5 publications

References 24 publications

A rare adverse event of atorvastatin inducing leukocytoclastic vasculitis with ANCA‐negative (Anti‐Neutrophil cytoplasmic antibody) case report and literature review

A rare adverse event of atorvastatin inducing leukocytoclastic vasculitis with ANCA‐negative (Anti‐Neutrophil cytoplasmic antibody) case report and literature review

Statin Use in Relation to COVID-19 and Other Respiratory Infections: Muscle and Other Considerations

Cholesterol Management in Neurology: Time for Revised Strategies?

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