Clinicians should consider using PCSK9 inhibitors to lower cholesterol in patients with statin-associated autoimmune myopathy. Findings from a case report are published in the Annals of Internal Medicine.
Beyond its toxic effect, statin use has been associated with a rare but potentially severe and disabling type of muscle disease known as statin-associated autoimmune myopathy. Its distinguishing features are the persistence after withdrawal of statins and its association with antibodies against 3-hydroxy-3methylglutaryl coenzyme A reductase (HMGCR). Management usually requires steroids and other immunosuppressive therapies. Other cholesterol-lowering medications and dietary supplements can cause or worsen this myopathy, which makes decreasing cholesterol levels very challenging in these patients. Treatment with PCSK9 monoclonal antibodies is a relatively new way to decrease cholesterol levels and cardiovascular morbidity and mortality in high-risk patients.
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