The incidence of anti-HMGCR immune-mediated necrotizing myopathy: an Australian and UK retrospective multi-site cohort study
Abstract
Abstract Objectives Immune-mediated necrotizing myopathy (IMNM) with autoantibodies targeting 3-hydroxy-3-methylglutaryl-CoA reductase (anti-HMGCR) is considered a rare complication of statin therapy. We calculate the incidence of anti-HMGCR IMNM and describe clinical characteristics in four independent cohorts: Manchester (UK), Bristol (UK), Western Australia (WA, Australia) and South Australia (SA, Australia). Methods Adults (≥18 years) with anti-HMGCR IMNM (ENMC criteria; 2018–2023) were identified from myositis clinic and laboratory records. Nationwide UK anti-HMGCR testing was performed at Oxford University Hospital Laboratories and state-based WA/SA testing at PathWest Laboratories. Results One hundred and nine anti-HMGCR IMNM cases were identified (51% female, median 66 years [IQR 58–72.2]) with median follow-up 2.3 years [IQR 1.5–4.2]. Mean annual incidence was 2.9 cases/million person-years. In statin users, incidence was 20.4 (UK) and 24.1 (WA/SA) cases/million statin-users/year. One hundred and one patients were statin-exposed, mostly atorvastatin (77/101, 76.2%). Median statin duration before diagnosis was 3 years (range: 1 month–23 years). Eight (7.5%) were statin-naïve and, compared with statin-exposed patients, younger (median 46.1 vs 67 years, P = 0.02), frequently of non-white ethnicity (5/8 vs 20/77, P = 0.04) and more commonly had dysphagia (4/8 vs 14/94, P = 0.03). The median peak creatine kinase (CK) was 7020 IU/l (range: 964–39076), and 48/105 (45.7%)…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
Read the paper
Related studies
- Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials
- Tocilizumab in patients with severe COVID-19: a retrospective cohort study
- A new aging measure captures morbidity and mortality risk across diverse subpopulations from NHANES IV: A cohort study
- Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study
- Are noise and air pollution related to the incidence of dementia? A cohort study in London, England
- Long COVID symptoms and duration in SARS-CoV-2 positive children — a nationwide cohort study
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.