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Statin-induced myositis, often with anti-HMGCR autoantibodies can be difficult to manage, Arthritis Research & Therapy yhas published the experience of 55 patient with HMGCR myopathy, demonstrating that while steroid management may be reasonable in select patients, the use of triple steroid/IVIG/SSI was very efficacious in induction.
Of the 55 patients, 14 patients achieved remission with this corticosteroid-free induction strategy (25%).
Those treated with corticosteroids (n=41), only 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, P = 0.015). Avoiding delays, especially in patients with normal strength, may reset the natural history of anti-HMGCR myopathy from a refractory entity to a treatable disease.
Thus, induction with corticosteroids + IVIG + a corticosteroid-sparing immunosuppressant appears efficacious and may allow accelerated corticosteroid tapers.