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Multicenter Study
. 2018 Sep 1;178(9):1224-1229.
doi: 10.1001/jamainternmed.2018.2859.

Association of Statin Exposure With Histologically Confirmed Idiopathic Inflammatory Myositis in an Australian Population

Gillian E Caughey  1   2   3 , Genevieve M Gabb  4   5   6 , Saffron Ronson  3 , Michael Ward  3 , Timothy Beukelman  7 , Catherine L Hill  5   8   9   10 , Vidya Limaye  5   10
Affiliations
Multicenter Study

Association of Statin Exposure With Histologically Confirmed Idiopathic Inflammatory Myositis in an Australian Population

Gillian E Caughey et al. JAMA Intern Med. .

Erratum in

  • Incorrect Colors in Figure Keys.
    [No authors listed] [No authors listed] JAMA Intern Med. 2018 Dec 1;178(12):1732. doi: 10.1001/jamainternmed.2018.6618. JAMA Intern Med. 2018. PMID: 30383078 Free PMC article. No abstract available.

Abstract

Importance: Statin medications are widely prescribed for cardiovascular risk reduction. Myalgia and rhabdomyolysis are well-recognized adverse effects of statins, and they resolve with the cessation of statin therapy. Idiopathic inflammatory myositis (IIM) is a heterogeneous group of autoimmune myopathies that may also be associated with statin use. Recently, statin-associated autoimmune myopathy has been recognized as a distinct entity with the presence of specific autoantibodies against hydroxymethylglutaryl-coenzyme A reductase, which results in a necrotizing myositis that does not resolve with cessation of statin therapy and requires treatment with immunosuppressive agents.

Objective: To examine the association between histologically confirmed IIM and current exposure to statin medications.

Design, setting, and participants: Population-based case-control study using the South Australian Myositis Database of all histologically confirmed cases of IIM diagnosed between 1990 and 2014 in patients 40 years or older (n = 221) and population-based controls from the North West Adelaide Health Study (n = 662), matched by age and sex in a 3:1 ratio of controls to cases. Data analysis using conditional logistic regression was performed from June 1, 2016, to July 14, 2017.

Exposures: Current statin medication use.

Main outcomes and measures: Unadjusted and adjusted (for diabetes and cardiovascular disease) odds ratios and 95% CIs for likelihood of inflammatory myositis.

Results: A total of 221 IIM cases met the inclusion criteria with a mean (SD) age of 62.2 (10.8) years, and 132 (59.7%) were female. Statin exposure at the time of IIM diagnosis was 68 of 221 patients (30.8%) and 142 of 662 matched controls (21.5%) (P = .005). There was an almost 2-fold increased likelihood of statin exposure in patients with IIM compared with controls (adjusted odds ratio, 1.79; 95% CI, 1.23-2.60; P = .001). Similar results were observed when patients with necrotizing myositis were excluded from the analysis (adjusted odds ratio, 1.92; 95% CI, 1.29-2.86; P = .001).

Conclusions and relevance: In this large population-based study, statin exposure was significantly associated with histologically confirmed IIM. Given the increased use of statins worldwide and the severity of IIM, increased awareness and recognition of this potentially rare adverse effect of statin exposure is needed.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Gabb reported receiving speaker fees from AstraZeneca, Pfizer, and the Pharmaceutical Society of Australia, and consulting for Therapeutic Goods Administration Australia, Adelaide. Dr Beukelman reported receiving consulting fees from UCB, Sobi, Novartis, Genentech/Roche, and Bristol-Myers Squibb. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Prevalence of Specific Types of Disease Among 221 Patients With Idiopathic Inflammatory Myositis in Southern Australia
Figure 2.
Figure 2.. Idiopathic Inflammatory Myositis Cases, Proportion of Cases With Statin Exposure, and Rate of Dispensing Statin Medication in the Australian Population Between 2000 and 2014
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