Immune-mediated necrotizing myopathy associated with statins

Muscle Nerve. 2010 Feb;41(2):185-90. doi: 10.1002/mus.21486.


We report patients from two neuromuscular centers who were evaluated between the years 2000 and 2008 and met the following criteria: (1) proximal muscle weakness occurring during or after treatment with statins; (2) elevated serum creatine kinase (CK); (3) persistence of weakness and elevated CK despite discontinuation of the statin; (4) improvement with immunosuppressive agents; and (5) muscle biopsy showing necrotizing myopathy without significant inflammation. Twenty-five patients fulfilled our inclusion criteria. Twenty-four patients required multiple immunosuppressive agents. Fifteen patients relapsed after being tapered off immunosuppressive therapy. Exposure to statins prior to onset was significantly higher in patients with necrotizing myopathy (82%) as compared to those with dermatomyositis (18%), polymyositis (24%), and inclusion-body myositis (38%) seen in the same time period. The lack of improvement following discontinuation of statins, the need for immunosuppressive therapy, and frequent relapse when treatment was tapered suggest an immune-mediated etiology for this rare, statin-associated necrotizing myopathy.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biopsy
  • Creatine Kinase / blood
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects*
  • Immune System / physiology*
  • Immunosuppressive Agents / therapeutic use
  • Immunotherapy
  • Male
  • Middle Aged
  • Muscle Weakness / pathology
  • Muscle Weakness / physiopathology
  • Muscle, Skeletal / pathology*
  • Muscle, Skeletal / physiopathology
  • Muscular Diseases / chemically induced*
  • Muscular Diseases / drug therapy
  • Muscular Diseases / immunology*
  • Necrosis
  • Retrospective Studies
  • Withholding Treatment


  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Immunosuppressive Agents
  • Creatine Kinase