Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Can J Cardiol. 2017 May;33(5):666-673. doi: 10.1016/j.cjca.2017.02.013. Epub 2017 Mar 2.
Statin-associated muscle symptoms (SAMS) are common. Rechallenge with the same statin (same-statin rechallenge) has recently been included as part of a proposed scoring index for diagnosing SAMS, but data regarding tolerability and efficacy of same-statin rechallenge, compared with other strategies, is minimal. In this study we evaluated the tolerability, percent change in low-density lipoprotein cholesterol (LDL-C), and proportion of patients achieving their LDL-C targets among 3 common management strategies-same-statin rechallenge, switching to a different statin (statin switch), and use of nonstatin medications only.
We performed a retrospective analysis of 118 patients referred to our tertiary care centre for management of SAMS, defined as development of muscle-related symptoms with 2 or more statins. Baseline and last follow-up lipid parameters were documented. Patients were classified as tolerant of a strategy if, at their last follow-up, they remained on that strategy.
After a median follow-up of 17 months, most (n = 79; 67%) patients were able to tolerate a statin. Tolerability was similar among the 3 treatment strategies (71% same-statin rechallenge vs 53% statin switch vs 57% for nonstatin therapy only; P = 0.11). Those in the same-statin rechallenge and statin switch groups achieved greater LDL-C reductions compared with those who only tolerated nonstatins (-38.8 ± 3.4% vs -36.4 ± 2.9% vs -17.3 ± 4.5%; P = 0.0007). A greater proportion of patients in the same-statin rechallenge group achieved their target LDL-C compared with those in the nonstatin therapy only group (50% vs 15%; odds ratio, 6.8; 95% confidence interval, 1.5-40.7; P = 0.04).
Among individuals with a history of SAMS, most will tolerate statin therapy. Same-statin rechallenge was highly tolerable and efficacious. Thus, same-statin rechallenge might warrant increased utilization.
他汀类药物相关肌肉症状（SAMS）很常见。最近，同一种他汀类药物（同种他汀类药物再挑战）被纳入诊断 SAMS 的评分指数的一部分，但与其他策略相比，同种他汀类药物再挑战的耐受性和疗效的数据很少。在这项研究中，我们评估了 3 种常见管理策略（同种他汀类药物再挑战、转换为另一种他汀类药物（他汀类药物转换）和仅使用非他汀类药物）的耐受性、低密度脂蛋白胆固醇（LDL-C）的百分比变化以及达到 LDL-C 目标的患者比例。
我们对 118 名因 SAMS 而被转诊至我们的三级护理中心的患者进行了回顾性分析，SAMS 的定义是使用 2 种或更多种他汀类药物后出现与肌肉相关的症状。记录基线和最后一次随访时的脂质参数。如果患者在最后一次随访时仍在使用该策略，则将其归类为该策略可耐受。
中位随访 17 个月后，大多数（n=79；67%）患者能够耐受他汀类药物。3 种治疗策略的耐受性相似（同种他汀类药物再挑战组 71%，他汀类药物转换组 53%，仅用非他汀类药物治疗组 57%；P=0.11）。与仅耐受非他汀类药物的患者相比，同种他汀类药物再挑战组和他汀类药物转换组的 LDL-C 降低幅度更大（-38.8±3.4% vs.-36.4±2.9% vs.-17.3±4.5%；P=0.0007）。与仅用非他汀类药物治疗的患者相比，同种他汀类药物再挑战组中有更多的患者达到了 LDL-C 目标（50% vs 15%；优势比，6.8；95%置信区间，1.5-40.7；P=0.04）。
在有 SAMS 病史的人群中，大多数人会耐受他汀类药物治疗。同种他汀类药物再挑战具有良好的耐受性和疗效。因此，同种他汀类药物再挑战可能值得更多的应用。
