Muscle Pain and Weakness With Statin Treatment May Herald ALS

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Muscle Pain and Weakness With Statin Treatment May Herald ALS

http://www.medscape.com/viewarticle/581113?sssdmh=dm1.388716 & src=nldne

September 26, 2008 (Salt Lake City, Utah) — A new study has shown a high

proportion of patients with sporadic amyotrophic lateral sclerosis (ALS)

who were exposed to statin therapy prior to their diagnosis reported

muscle weakness and pain associated with statin treatment.

The finding builds on evidence from previous studies suggesting that

statin treatment is associated with more rapid progression of the

disease. The association in this study was limited to patients with

sporadic ALS.

" We're not saying that statins cause ALS, but they may accelerate the

course leading to diagnosis in some patients, " R. , MD,

director of the Carolinas Neuromuscular/ALS-MDA Center, in Charlotte,

North Carolina, told Medscape Neurology & Neurosurgery in an interview.

The results were presented here at the American Neurological Association

133rd Annual Meeting.

Statin Effects

It is well-known that patients receiving statins to treat

hypercholesterolemia and hypertriglyceridemia may have pain, cramps, or

weakness in muscle that resolves when the statin is withdrawn, Dr.

said. In rare instances, treatment is associated with myopathy or

rhabdomyolysis.

In the setting of ALS, a recent study by researchers at the University

of Toronto suggested that patients on statins had more rapid functional

decline than ALS patients not on statin therapy (Zinman L et al.

Amyotroph Lateral Scler. 2008;4:223-228).

Similar findings from French researchers have led these groups to

recommend that statins should not be used in patients with ALS, Dr.

said. " I think that's a standard that is slowly being adopted by

all neuromuscular practitioners. "

If statin use can accelerate disease progression, the researchers

hypothesized that patients with ALS might have experienced reactions to

statin therapy before their diagnosis. To examine this question, Dr.

reviewed statin use prior to diagnosis in 240 patients with

sporadic or familial motor neuron diseases, including ALS, primary

lateral sclerosis (PLS), dysimmune motor neuropathies, and atypical

motor neuron diseases.

They report that of 164 patients with sporadic ALS, 31 were exposed to

statins prior to their diagnosis. Of 28 of these patients who had

received a single statin, 11 had reported treatment-associated muscle

pain and increased weakness prior to their diagnosis. The 3 remaining

patients had each been treated with 3 statins and had reported pain and

weakness with each 1. In all patients, diagnosis occurred within 12

months of these complaints related to statin treatment.

Of the 18 familial ALS patients, neither of 2 statin-treated patients

showed this phenomenon, Dr. noted. Of 20 PLS patients, 1 of 2

patients who had received a single statin and 1 patient who had received

treatment with multiple statins had symptoms. There was no statin use

among 14 patients with dysimmune motor neuropathies or atypical motor

neuron disease prior to diagnosis.

They examined comorbidities to ALS that appeared to increase the risk

for this phenomenon and found that, in patients with sporadic ALS and

diabetes or ALS and hypothyroid, 2 of 8 patients who had received a

single statin and 4 of 6 patients who had received multiple statins had

muscle symptoms prior to diagnosis of ALS.

One possible explanation for this is the genetic background of ALS

patients in the face of an environmental challenge such as statin

therapy, Dr. noted. However, they do not have the genetic

background of these particular patients.

" So this is just an epidemiological statement saying that in those

patients who were exposed to statins who eventually developed a

diagnosis of ALS, half of them will have pain and weakness associated

with the first exposure to the statin, and that very often leads to a

diagnosis of ALS. It may not be a cause, but it may be a trigger of the

disease process that leads them to go to a neurologist and get diagnosed. "

" I think that more and more people are concerned about potential side

effects of statins, " he added, with a growing literature on

muscle-specific and some cognitive issues related to treatment. " Statins

are a double-edged sword. They may be good for some diseases and not

other diseases, they may be good in some people and not in other people,

and one has to be very careful when initiating them. "

Doctors prescribing statins should pay close attention to adverse

effects, he said. " Overall, the use of statins is very good and has

excellent effects on a large number of people, " he concluded. " We're

talking about a subgroup of people who may be at risk for a relatively

rare statin complication. "

The study was funded in part by the Muscular Dystrophy Association and

Department of Veterans Affairs. Dr. reports no conflict of interest.

American Neurological Association 133rd Annual Meeting: Abstract M-9.

Presented September 22, 2008.