Challenges in Treating Statin-Associated Necrotizing Myopathy

Table 1

Summary of patients.

Patient	Age (years)	Sex	CK level (IU/L)	Anti-HMGCR antibody level (U/mL)	Primary biopsy findings	Statin	Therapy
1	71	Female	13,871	>200	Degenerating and regenerating muscle fibers without inflammation	Atorvastatin	Prednisone, methylprednisolone, AZA
2	54	Female	24,300	>200	Many regenerating and occasional necrotic muscle fibers with mild, patchy inflammation	Atorvastatin	Prednisone, MMF, IVIG
3	64	Female	14,000	167	Necrotic muscle fibers	Atorvastatin, simvastatin	Prednisone, MTX, AZA, rituximab, MMF, IVIG
4	76	Male	6,333	131	Numerous regenerating, degenerating, and atrophic muscle fibers without inflammation	Atorvastatin	Prednisone, MTX, IVIG, AZA, MMF
5	66	Male	8,790	>200	Few, atrophic muscle fibers	Atorvastatin	None
6	69	Male	9,770	>200	Degenerating and regenerating muscle fibers without signs of inflammation	Atorvastatin	Prednisone, AZA, IVIG
7	72	Male	7,802	192	Numerous degenerating and regenerating fibers without inflammation	Atorvastatin	None

HMGCR = HMG-CoA reductase, AZA = azathioprine, IVIG = intravenous immunoglobulin, MMF = mycophenolate mofetil, and MTX = methotrexate.