Statin-induced myopathy does not typically require lifelong immunosuppressant therapy. The management of statin-induced myopathy primarily involves modifications to the statin regimen and, in some cases, the addition of non-statin therapies.
Treatment modifications
- Statin regimen adjustments: The AAPA/ABC/ACC/ACPM/ADA/AGS/AHA/APhA/ASPC/PCNA 2019 guidelines recommend switching to moderate-intensity statin therapy in patients with clinical ASCVD who experience statin-associated side effects on high-intensity statin therapy . Additionally, a rechallenge with a modified dosing regimen or an alternate statin may be considered to achieve maximal LDL-C reduction
- Non-statin therapies: In patients with severe or recurrent statin-associated muscle symptoms, switching to non-statin therapy may be considered . For intermediate-risk adult patients requiring more aggressive LDL-C reduction but not tolerating high-intensity statin therapy, adding a non-statin drug such as ezetimibe or a bile acid sequestrant to moderate-intensity statin therapy may be considered
Pharmacogenomic insights
- Genotyping: Variation in the SLCO1B1 gene is associated with an increased incidence of statin-induced myopathy, particularly with simvastatin. Genotyping in patients suffering from statin-induced myopathy may help personalize the choice of statin for the lowest chance of developing myopathy
Coenzyme Q10
- Coenzyme Q10 supplementation: Statin treatment reduces circulating levels of CoQ10, which plays a role in mitochondrial energy production. While there is insufficient evidence to prove the etiologic role of CoQ10 deficiency in statin-associated myopathy, CoQ10 supplementation can be tested in patients requiring statin treatment who develop statin myalgia and cannot be satisfactorily treated with other agents
In conclusion, the management of statin-induced myopathy involves modifications to the statin regimen, the potential addition of non-statin therapies, and consideration of pharmacogenomic insights. Lifelong immunosuppressant therapy is not typically required.