Therapeutic challenges and cardiovascular risk in patients with HMGCR-associated immune-mediated necrotizing myopathy (HMGR-IMNM) secondary to statins

Idiopathic inflammatory myopathies (IIM) are connective tissue diseases (CTD) that involve muscle with varying severity [ [1] Pinal-Fernandez I. Casal-Dominguez M. Mammen A.L. Immune-mediated necrotizing myopathy. Curr Rheumatol Rep. 2018; 20: 21 Crossref PubMed Scopus (128) Google Scholar ]. They include polymyositis, dermatomyositis, overlap myositis, inclusion body myositis, and immune-mediated necrotizing myopathies (IMNM). IMNM is characterized by muscle fiber necrosis and myophagocytosis without frequent lymphocytic infiltrates. Based on associated antibodies, subtypes are classified into IMNM with two positive myositis-specific autoantibodies (MSAs), anti-SRP (signal recognition particle) or anti-HMGCR antibodies, and seronegative IMNM [ [1] Pinal-Fernandez I. Casal-Dominguez M. Mammen A.L. Immune-mediated necrotizing myopathy. Curr Rheumatol Rep. 2018; 20: 21 Crossref PubMed Scopus (128) Google Scholar , [2] Allenbach Y. Drouot L. Rigolet A. Charuel J.L. Jouen F. Romero N.B. et al. Anti-HMGCR autoantibodies in european patients with autoimmune necrotizing myopathies. Medicine (Baltimore). 2014; 93: 150-157 Crossref PubMed Scopus (210) Google Scholar ].