OBJECTIVE To describe successful therapeutic strategies in statin-induced anti-HMGCR myopathy. METHODS Retrospective data from a cohort of 55 patients with statin-induced anti-HMGCR myopathy, sequentially stratified by the presence of proximal weakness, early remission, and corticosteroid and IVIG use at treatment induction, were analyzed for optimal successful induction and maintenance of remission strategies. RESULTS A total of 14 patients achieved remission with a corticosteroid-free induction strategy (25%). In 41 patients treated with corticosteroids, only 4 patients (10%) failed an initial triple steroid/IVIG/steroid-sparing immunosuppressant (SSI) induction strategy. Delay in treatment initiation was independently associated with lower odds of successful maintenance with immunosuppressant monotherapy (OR 0.92, 95% CI 0.85 to 0.97, P = 0.015). While 22 patients (40%) presented with normal strength, only 9 had normal strength at initiation of treatment. CONCLUSION While corticosteroid-free treatment of anti-HMGCR myopathy is now a safe option in selected cases, initial triple steroid/IVIG/SSI was very efficacious in induction. Delays in treatment initiation and, as a corollary, delays in achieving remission decrease the odds of achieving successful maintenance with an SSI alone. Avoiding such delays, most notably in patients with normal strength, may reset the natural history of anti-HMGCR myopathy from a refractory entity to a treatable disease.

中文翻译：

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他汀类药物诱导的抗HMGCR肌病：55位患者无皮质类固醇缓解的成功治疗策略。

目的描述他汀类药物诱导的抗HMGCR肌病的成功治疗策略。方法回顾性分析55例他汀类药物诱导的抗HMGCR肌病患者的回顾性数据，依次按近端无力，早期缓解以及在治疗诱导时使用皮质类固醇和IVIG进行分层，以最佳成功诱导和维持缓解策略。结果共有14例患者采用无糖皮质激素诱导策略缓解（25％）。在接受皮质类固醇治疗的41例患者中，只有4例（10％）在最初的三重类固醇/ IVIG /保留类固醇的免疫抑制剂（SSI）诱导策略失败。治疗开始时间的延迟与免疫抑制剂单一疗法成功维持的可能性较低独立相关（OR 0.92，95％CI 0.85至0.97，P = 0。015）。虽然22名患者（40％）表现出正常的力量，但是只有9名患者在开始治疗时具有正常的力量。结论虽然在某些情况下，无皮质类固醇激素治疗抗HMGCR肌病是一种安全的选择，但最初的三联类固醇/ IVIG / SSI的诱导非常有效。延迟治疗的开始以及必然的是，获得缓解的延迟降低了仅靠SSI成功维持治疗的几率。避免这种延迟，最明显的是在具有正常强度的患者中，可以将抗HMGCR肌病的自然病史从难治性疾病重设为可治疗的疾病。最初的三联类固醇/ IVIG / SSI在诱导中非常有效。延迟治疗的开始以及必然的是，获得缓解的延迟降低了仅靠SSI成功维持治疗的几率。避免这种延迟，最明显的是在具有正常强度的患者中，可以将抗HMGCR肌病的自然病史从难治性疾病重设为可治疗的疾病。最初的三联类固醇/ IVIG / SSI在诱导中非常有效。延迟治疗的开始以及必然的是，获得缓解的延迟降低了仅靠SSI成功维持治疗的几率。避免这种延迟，最明显的是在具有正常强度的患者中，可以将抗HMGCR肌病的自然病史从难治性疾病重设为可治疗的疾病。