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Treatment and outcomes in anti-HMG-CoA reductase-associated immune-mediated necrotising myopathy. Comparative analysis of a single-centre cohort and published data
J.-G. Rademacher1, S. Glaubitz2, S. Zechel3, M. Oettler4, B. Tampe5, J. Schmidt6, P. Korsten7
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany.
- Department of Neurology, University Medical Centre Göttingen, Germany.
- Institute of Neuropathology, University Medical Centre Göttingen, Germany.
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany.
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany.
- Department of Neurology, University Medical Centre Göttingen; Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, and Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany.
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Germany. peter.korsten@med.uni-goettingen.de
CER15285
2022 Vol.40, N°2
PI 0320, PF 0328
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PMID: 35225222 [PubMed]
Received: 28/10/2021
Accepted : 06/12/2021
In Press: 25/02/2022
Published: 25/02/2022
Abstract
OBJECTIVES:
Anti-hydroxy-methyl-glutaryl-coenzyme A reductase (HMGCR) antibody-associated myopathy was recognised as a new form of immune-mediated necrotising myopathy (IMNM) a decade ago. Due to the rarity of the disease, only limited data on clinical manifestations and therapeutic outcomes are available.
METHODS:
We retrospectively analysed a monocentric cohort of HMGCR-associated IMNM patients treated at the University Medical Centre Göttingen. Clinical, laboratory, and biopsy data, as well as treatment outcomes, were analysed. In addition, a literature search was performed on published HMGCR IMNM cohorts in Medline and Web of Science.
RESULTS:
We identified nine patients; five were female. The median age was 68 years (47-77). Six were statin-exposed and older than statin-naive patients (71 years [65-77] vs. 51 years [47-67]). All had muscle weakness, seven myalgias. Strength (MRC sum score) was 53/65 (46-61) at baseline and increased to 63/65 (50-65) with therapy. Creatine kinase (CK) levels decreased from a median level of 12837 U/L (range 6346-25011) to 624 U/L (35-1564 U/L). All received glucocorticoids (GC) and at least one immunosuppressive therapy. The literature review identified 26 studies comprising 691 patients. 57.9% were female, 61.3% statin exposed. 95.2% had weakness, 39.1% myalgia. Dysphagia affected 28.8%. 84.9% received GC and a median of 1.5 additional immunosuppressants. Compared to published data, our patients had higher baseline CK values (12837 [6346-25011] vs. 6951 [2539-10500], p<0.001), and we used azathioprine and intravenous immunoglobulins (p<0.001) more frequently but methotrexate and rituximab less frequently (p<0.001).
CONCLUSIONS:
HMGCR-associated IMNM is a rare subset of myositis. With systemic treatment, patients usually achieve partial or complete remission. Optimal treatment has not been established, but glucocorticoids, azathioprine, and methotrexate are generally effective with or without intravenous immunoglobulins.
