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
Written by |
- 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.
Leave a comment
Fill in the required fields to post. Your email address will not be published.