Management Strategies for Statin-Associated Muscle Symptoms: How Useful Is Same-Statin Rechallenge?
Abstract
Background 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. Methods 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. Results 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…
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23 studies were included for data extraction, with 9 RCTs analyzed quantitatively.
“23 studies were included for data extraction [20–26,35–50], with 9 RCTs analyzed quantitatively.”
All 8 identified retrospective studies were of low quality, mainly due to concerns regarding residual confounding because of lack of adjustment.
“Notably all 8 identified retrospective studies were of low quality, mainly due to concerns regarding residual confounding because of lack of adjustment (S2 File) [35,36,38,41,42,44,45,50].”
We included eight retrospective cohort studies and two prospective cohort studies.
“We included eight retrospective cohort studies [35,38,39,41,42,44,45,50] and two cohort prospective studies [36,37] (S4 File, Table 2).”
Three studies reported the incidence of muscle symptoms, five studies provided data on treatment discontinuation due to muscle symptoms, and eight studies reported on effectiveness.
“Three studies reported the incidence of muscle symptoms [36–38], five studies provided data on treatment discontinuation due to muscle symptoms [36,37,39,42,45], and eight studies reported on effectiveness [35–37,39,41,44,45,50].”
The studies varied in minimum number of previously tried statin or various creatinine kinase thresholds.
“The studies varied in minimum number of previously tried statin [35,39,40,46] or various creatinine kinase thresholds [37,43].”
The discontinuation rate was similar when comparing a same-statin rechallenge, statin switch and a non-statin based therapy.
“This was also reported when comparing a same-statin rechallenge, statin switch and a non-statin based therapy [35].”
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Effect of statins on skeletal muscle function
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Self-citationA randomized trial of Coenzyme Q10 in patients with confirmed statin myopathy
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Aebi, P. S., Villoz, F., Bührer, J., Lyko, C., Abolhassani, N., Del Giovane, C., Gencer, B., Rodondi, N., & Blum, M. R. (2025) · PLOS One · doi:10.1371/journal.pone.0338575
“We included eight retrospective cohort studies [35,38,39,41,42,44,45,50] and two cohort prospective studies [36,37] (S4 File, Table 2).”
Influential
- Authors
- Brennan, E. T., & Joy, T. R.
- Affiliations
- Western University (CA)
- Corresponding author
- Joy, Tisha R.
- ORCID
- Joy, Tisha R.
- Venue
- Canadian Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2017-05
- Volume
- 33
- Issue
- 5
- Pages
- 666-673
- ISSN
- 0828-282X (ISSN-L)
- OpenAlex
- W2593300661
- Cited by
- 5
- References
- 7
- Citations by year
- 2024: 2 · 2023: 1 · 2020: 1 · 2019: 1
- FWCI
- 0.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Canadian Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly Canada
- Merck
- Novo Nordisk
- Sanofi
- Amgen
- AstraZeneca
- Boehringer Ingelheim
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Keywords
- statin-associated muscle symptoms, statin intolerance, statin switching, non-statin lipid-lowering therapy, LDL cholesterol lowering, LDL-C goal attainment, statin tolerability
- MeSH terms
- Aged, Canada, Female, Humans, Hypercholesterolemia, Cholesterol, LDL, Male, Middle Aged, Muscular Diseases, Retrospective Studies, Treatment Outcome, No-Observed-Adverse-Effect Level, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lipid Metabolism, Medication Therapy Management, Drug Substitution
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