Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan.
Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
J Neurol Sci. 2024 Sep 15;464:123154. doi: 10.1016/j.jns.2024.123154. Epub 2024 Jul 31.
INTRODUCTION/AIMS: The common presentations of statin intolerance are muscle-specific symptoms. Although statins are one type of drug reported to cause myasthenic worsening, myasthenic worsening has not been recognized as statin intolerance. The purpose of the present study is to investigate in a large cohort the safety profiles of statins in patients with myasthenia gravis (MG).
A total of 1710 consecutive patients with MG who visited sites associated with the Japan MG registry 2021 group between April and October 2021 were reviewed. Statin-associated myasthenic worsening was defined as worsening of any myasthenic symptoms on statin use and improvement of the symptom by stopping the statin or by undertaking additional treatment with patient and doctor confirmation.
Among the 400 patients who used statins, 8 (2%) patients experienced statin intolerance and 6 (1.5%) patients experienced myasthenic worsening. No patients developed MG on the statin. Ptosis was a main symptom of myasthenic worsening in 4 (67%) patients. Atorvastatin was used in all patients with statin-associated myasthenic worsening. The symptoms of statin intolerance and statin-associated myasthenic worsening were improved within 2 months and 3 months, respectively, in all patients by cessation of statin use.
Regarding statin-associated myasthenic worsening, prevalence was low, and severity was mild; with cessation of statin use, symptoms improved within a few months, and outcomes were generally good. Although statins can be used in MG patients with little concern, statin-associated myasthenic worsening should be noted in addition to the classical statin intolerance associated with statin use.
简介/目的：他汀类药物不耐受的常见表现为肌肉特异性症状。虽然他汀类药物是一种据报道会导致肌无力恶化的药物，但肌无力恶化尚未被认为是他汀类药物不耐受。本研究的目的是在大型队列中调查他汀类药物在重症肌无力（MG）患者中的安全性概况。
回顾了 2021 年 4 月至 10 月期间，日本 MG 登记 2021 组相关站点就诊的 1710 例连续 MG 患者。他汀类药物相关肌无力恶化定义为使用他汀类药物时任何肌无力症状恶化，以及通过停用他汀类药物或通过患者和医生确认的额外治疗改善症状。
在使用他汀类药物的 400 例患者中，有 8 例（2%）患者出现他汀类药物不耐受，6 例（1.5%）患者出现肌无力恶化。没有患者在他汀类药物上发生 MG。眼睑下垂是 4 例（67%）肌无力恶化患者的主要症状。所有他汀类药物相关肌无力恶化患者均使用阿托伐他汀。所有患者均因停用他汀类药物，在 2 个月和 3 个月内分别改善了他汀类药物不耐受和他汀类药物相关肌无力恶化的症状。
关于他汀类药物相关肌无力恶化，其患病率较低，严重程度较轻；停用他汀类药物后，症状在几个月内得到改善，总体预后良好。虽然可以在 MG 患者中谨慎使用他汀类药物，但除了与使用他汀类药物相关的经典他汀类药物不耐受外，还应注意他汀类药物相关肌无力恶化。
