RESEARCH - Tendon problems a possible adverse effect of statin therapy

[Guest guest]

Tendon Problems a Possible Adverse Effect of Statin Therapy CME

News Author: O'Riordan

CME Author: Laurie Barclay, MD

From Heartwire — a professional news service of WebMD

March 5, 2008 — A new review published this week suggests that tendon

impairments might be another side effect associated with the use of

statins [1]. Published online February 29, 2008 in Arthritis &

Rheumatism: Arthritis Care & Research, the review suggests that

clinicians be aware of the possibility of tendon complications,

including tendonitis and even tendon rupture, especially in patients

who might be at higher risk of developing these side effects.

Those who might be at greater risk, write lead investigator Dr

Isabelle Marie (Rouen University Hospital, France) and colleagues,

include patients with metabolic disorders, patients who exert

themselves physically throughout the day, and patients taking other

drugs that might increase the toxicity of statins, such as steroids or

antibiotics like fluoroquinolone.

The authors stress, however, that statin-associated tendon impairments

are extremely rare, and none have been reported in pre- and

postmarketing studies, including all the large statin trials.

Anecdotal reports, however, have been described in the literature.

With the anecdotal evidence in mind, the group retrospectively sought

to identify all tendinous disorders attributable to statin therapy

over a 15-year period. From 1990 to 2005, 96 spontaneous reports of

tendon complications were reported to 31 French Pharmacovigilance

Centers.

The average age of those who experienced problems was 56 years. The

median time to onset of the side effect was 243 days, although

complications arose in one patient within 24 hours of taking the

statin. Nearly one-third of those experiencing tendon complications

had an associated condition that favored the onset of tendon side

effects, such as diabetes, hyperuricemia, and participation in sports.

The most common complication was tendonitis, followed by tendonitis

with tendon rupture and de novo tendon rupture. Marie and colleagues

note that complications were serious enough for 17 patients to report

to a hospital, and 19 patients had significant functional

difficulties, such as problems walking, decreased flexion, bruising,

and pain.

The researchers write that the tendon disorders could be reasonably

attributed to statin therapy because " there was a temporal

relationship between onset of tendinous signs and the initiation of

statin therapy. " The problems cleared up or improved after stopping

the drugs and recurred in seven patients who were restarted on

statins.

The authors note that the side effects occurred with all the

statins—atorvastatin, fluvastatin, pravastatin, rosuvastatin, and

simvastatin—but that there is no known reason why the drugs might

produce these injuries. Current French recommendations include tendon

disorders on the list of adverse effects of statins, but future

studies are needed to confirm the relationship and to determine the

prevalence and incidence of statin-associated tendinopathy, conclude

the group.

Source

Marie I, Delafenêtre H, Massy N, et al. Tendinous disorders attributed

to statins: A study on ninety-six spontaneous reports in the period

1990-2005 and review of the literature. Arthritis Care Res.

2008;59:367-372.

http://www.medscape.com/viewarticle/571031

--

Not an MD