How do you decide on initiation of treatment with steroids or immunomodulatory therapy in patients with statin-induced myopathy versus statin-induced autoimmune necrotizing myopathy?
In patients presenting with likely statin-induced myopathy versus statin-induced autoimmune necrotizing myopathy - how do you approach the decision regarding whether or not to start steroids/IVIG/immunomodulatory therapy while awaiting the results of the Anti-HMG CoA reductase antibody to return? Are there any drawbacks to waiting to start therapy until the antibody testing returns?
Answer from: at Academic Institution
In the setting of a hospitalized patient with rhabdomyolysis, the differential between statin toxicity and statin-associated IMNM can be difficult. All diagnostic modalities (muscle biopsy, EMG, muscle MRI) in the acute setting cannot discriminate, so we can only rely on the antibody. Fortunately, t...
Answer from: at Community Practice
If the patient has apparent muscle weakness, I give IVIG until the HmG- COA antibody result is back. I avoid steroids as they can be detrimental if it is only rhabdomyolysis.
Isn’t the dose of IViG 0.4gm/kg rather than ...