Efficacy of differing lipid-lowering management strategies in patients with a history of statin-related myopathy

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 723-739-Lipids: Therapeutics & Case Reports
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-727
Emily T Brennan*1 and Tisha Joy2
1University of Western Ontario, 2St. Joseph's Health Centre, London, ON, Canada
Context: Statin-related myopathy occurs in at least 10% of patients prescribed statins. Since there is no objective test for diagnosis, it is often difficult to discern statin-related myopathy from myopathy secondary to other causes. Consequently, statin therapy may be withdrawn in patients who would benefit from cardiovascular risk reduction. Management strategies for statin-related myopathy include: rechallenge, switching, alternate dosing schedules, or use of non-statin agents. There is limited data on the efficacy of these strategies in terms of tolerability and achievement of low-density lipoprotein cholesterol (LDL-C) goals.

Objectives: In patients with statin-related myopathy, our objectives were:

1. To determine tolerability of the above mentioned management strategies

2. To evaluate the efficacy of these strategies in achievement of LDL-C goals as per the Canadian Lipid Guidelines 2013

Methods: We conducted a retrospective analysis of patients with statin-related myopathy referred to a tertiary lipid centre (2007-2012). Patients with at least 1 follow-up visit and/or blood work were included. Outcomes evaluated included number and order of lipid-lowering agents tried, as well as achievement of LDL-C targets. Data is presented as mean ± standard deviation. Fisher’s exact tests and unpaired t-tests were used to compare proportions and LDL-C values, respectively.

Results: Of 162 patients referred, 116 individuals were included for analysis (age 64.1±11.6 years, 48% male, 87% high cardiovascular risk). On referral, 72% were intolerant to atorvastatin and 65% to rosuvastatin, reflecting the prescribing tendencies in Canada.  36% were on no therapy and 21% were on ezetimibe at the initial visit.  After a median follow-up of 15.5 months (range 1.5-60), 76% of patients tolerated statin therapy, with 49% on high dose therapy. Interestingly, 33% tolerated the 3rd statin trialed, and 63% tolerated a 4th statin. 41(35%) patients were uncertain of the cause their myalgias and agreed to a rechallenge. Of these, 73% tolerated the rechallenge.  LDL-C targets were achieved in 38% of the entire cohort.  Compared to those on non-statin therapy, those on statins more often achieved their LDL-C target (53% vs. 14%, p=0.001).

Conclusions:  Statin switching and rechallenge are useful and effective strategies for managing patients with statin-related myopathy, since individuals who remain on statin therapy demonstrate better achievement of their LDL-C targets.

Disclosure: TJ: Speaker Bureau Member, Merck & Co., Speaker Bureau Member, Novo Nordisk, Medical Advisory Board Member, Sanofi. Nothing to Disclose: ETB

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm