Benefits of statins may outweigh risks for many living with MG
The meds could cause short-term flares but appear to save lives long-term
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- For myasthenia gravis patients, statins may increase short-term flare risk.
- However, statins significantly lower the long-term risk of death in these patients.
- Individualized patient care is essential when considering statin use for myasthenia gravis.
While certain medications are typically avoided in myasthenia gravis (MG), a large-scale study from France suggests that cholesterol-lowering statins may actually reduce the overall risk of death in these patients.
The research indicates that although statins can slightly increase the short-term chance of a severe symptom flare-up, their long-term cardiovascular benefits appear to outweigh the potential risks for many living with the autoimmune disorder.
These findings challenge traditional clinical caution about “contraindicated” drugs, or medications usually red-flagged for MG patients, because they might worsen muscle weakness. The study provides new evidence to help doctors and patients weigh the immediate risks of a treatment against its potential to extend life.
“While further research is required, our study adds to the evidence base to inform future guidance and clinical decision-making regarding the use of statins and other contraindicated therapies in MG,” researchers wrote, noting that more robust official recommendations are needed.
The study, “Myasthenia Gravis Outcomes After Use of Statins and Other Contraindicated Treatments: Results From the French National Insurance Database,” was published in the European Journal of Neurology.
Risks associated with statins
MG occurs when the immune system mistakenly attacks the connection between nerves and muscles, leading to muscle weakness that can worsen with activity. Because certain medications can interfere with this neuromuscular signaling, clinical guidelines often advise doctors to avoid them.
These include statins, a group of medications used to lower cholesterol and reduce the risk of heart disease. Previous studies have reported a link between these medications and a higher risk of symptom worsening in people living with MG.
“Currently, most evidence on the effects of contraindicated treatments in MG, including statins, has been derived from case reports, small case series, or pharmacovigilance reports,” the researchers wrote. “To better inform clinical decision-making, data are needed from larger populations of patients with MG, with further assessment of the benefits and risks of medications according to patient and disease characteristics.”
In the study, a team analyzed data from more than 14,000 adults in the French national health insurance database. They found that nearly 90% of MG patients were prescribed at least one contraindicated medication from 2013 to 2020. This included antibiotics like fluoroquinolones, beta-blockers for heart health, and statins.
Nearly two-thirds of patients (62.8%) received an “absolutely contraindicated” medication, which ideally should never be used in MG. The most common were two types of antibiotics, fluoroquinolones and macrolides (about 30% of patients each), and beta-blockers (25.1%), used for heart conditions and high blood pressure.
Most participants (80%) received a “relatively contraindicated” medication. The most common were iodine contrast (a dye used in imaging tests; 56.4%), benzodiazepines (sedatives used for anxiety or sleep; 37.1%), and statins (28.8%).
The researchers focused on two major outcomes: admission to the intensive care unit (ICU) and death. The data revealed a complex “benefit-risk” profile. Overall, medications labeled as absolutely contraindicated were linked to a 25% higher risk of ICU admission and a 20% higher risk of death. During follow-up, 1,941 patients were admitted to the ICU for MG, and 2,430 died.
Statins, however, showed a unique pattern. Their use was significantly linked to a 13% higher risk of ICU admission for MG, but a 37% lower risk of death. This suggests that while statins might trigger a temporary flare-up, they are effective at preventing fatal heart attacks or strokes in the long run.
Analyses adjusted for the presence of any cardiovascular risk factor or simultaneous condition at the start of the study showed that statins were linked to an 8% higher risk of ICU admissions and a 39% lower risk of death.
The importance of individualized patient care
The impact of these medications also depended on a patient’s overall health, measured by the Charlson Comorbidity Index (CCI). For patients with fewer additional health problems, contraindicated drugs were more clearly linked to higher risks. However, for those with multiple co-occurring diseases, the benefits of treating those other conditions sometimes surpassed the risks to their MG management.
Disease duration also played a role. Patients in the first two years of their MG diagnosis were more prone to ICU admission when exposed to these medications, whereas those who had lived with the disease longer were more likely to face a higher risk of death following exposure.
“This real-world study… highlights the need for individualized approaches,” the researchers concluded. They noted that for many, especially those with high cardiovascular risks, the long-term protection provided by certain medications likely justifies the short-term risk of an MG exacerbation.
Elliott Grauman
My cardiologist was concerned with me continuing to use statins after I was diagnosed with MG in 2023. He prescribed Nexletol which is a non-statin. Then a new drug hit the market. Leqvio, is an injectable drug that after a loading dosage of two injections three months apart, I now get an injection every 6 months. So I continue to take Nexletol daily along with the Leqvio. My cholesterol numbers are the best they've ever been. I would encourage MG patients that take statins to ask their doctors about Leqvio and Nexletol.
Jodi Enders
Elliott, we appreciate you sharing what has worked for you. Managing cholesterol after an MG diagnosis can certainly be stressful and challenging. It's encouraging to hear that your numbers are the best they've been. I'm sure that stability brings some peace of mind. Sending good vibes! -Jodi, Patient Advocate
Wanda Jewett
I've read the report this article quotes regarding this "large" study. The study at only 14,700 participants is not a "large" study nor was it a long enough study nor did it address long term effects good or bad. What percentage of participants who took statins reached optimal levels of serum cholesterol and maintained them? How many of those who took statins could not stay on them. What percentage of those participants can continue taking them long term. What happens in 20 years or 20 years. On top of that only 28% (less than 4200) of those participants had even taken statins. That is way too few participants who have taken statins. The study seems to claim that the statins "may" have benefitted those participants since most of them seemed to have exacerbations of their myasthenia gravis that were able to be treated without serious damage.
The study posits that if the serum cholesterol was in fact lowered, statins may have been beneficial.
That is just not good enough. Statins don't just cause mild exacerbations. My MuSK antibody positive Myasthenia Gravis was actually precipitated by statins. I can never have them again. This article plays down the seriousness of the damage statins may cause. But many thousands of people with elevated cholesterol will never have a stroke or heart attack or any other damage from cholesterol. It also ignores the fact that there are several non-statin treatment for elevated cholesterol.
The article seems to be making blanket judgements. Did it take into consideration the various types of Myasthenia Gravis? We are not all the same.
I believe that unless your cholesterol is tremendously high, any cholesterol lowering drugs, and especially statins are risky.
There are however several cholesterol lowering drugs that are not statins so why push statins like this? With other treatments available Myasthenia gravis patients should not be asked to take statins.
Is it because of the multitude of payments mentioned in the "Conflicts of Interest" section of the study report?
Jodi Enders
Wanda, I understand how strongly you feel about this. You're right that not everyone with elevated cholesterol will go on to have a cardiac event. You're also right that MG is not one condition with one presentation, but rather it is highly individualized. Antibody type, unique health and genetic makeup, and individual response play a big role.
The article is to share what the data in this study suggested at a population level, not to push statins or dismiss non-statin options. For some, statins may pose too much risk. For others with significant cardiovascular disease, the response may need to be different. That is why conversations with doctors and MG specialists need to be personal and collaborative.
Thank you for speaking up. These discussions are complicated, and your perspective is valued. -Jodi, Patient Advocate