Statin challenges may allow some with myalgia to continue their regimen

In patients who had had myalgia while taking statins, double-blind, crossover comparisons objectively determined whether the drug was truly causing the problem and allowed the patients to continue therapy, a proof-of-concept study found.

Eight patients recruited from a tertiary lipid clinic in Canada who had previously tried and discontinued statin therapy due to myalgia were given either their statin or a placebo for up to 3 weeks, followed by 3-week washout periods.

Researchers determined weekly visual analogue scale (VAS) scores (range, 0 to 100 mm) for myalgia and for specific symptoms, pain interference scores, and pain severity scores during the 3-week treatment periods. Results appeared in the March 4 Annals of Internal Medicine.

Seven patients completed 3 treatment pairs, and 1 completed 2 treatment pairs after the first trial was interrupted by an acute medical condition. For each trial, no statistically significant differences were seen between statin and placebo in the VAS myalgia score, symptom-specific VAS score, pain interference score, and pain severity score.

After the conclusion of the trial, 1 patient's follow-up low-density lipoprotein cholesterol level was below the recommended target and the person did not continue on a statin. Five of the 7 remaining patients requiring statin therapy resumed and have continued to receive the statin for a median follow-up of 10 months (range, 5 to 18 months).

The researchers wrote that management of statin-related myalgia has primarily focused on continuing to administer a statin, if possible, by statin rechallenge, statin switching, or alternate dosing schedules. However, results are often confounded by other pains induced by fibromyalgia, arthritis, or a job with varying levels of physical exertion.

The researchers wrote, “Our findings show that not all patients developing myalgia during open-label statin treatment have true statin-related myopathy.”