Is there a role for PCSK9 inhibitors in patients with statin-associated immune mediated necrotizing myopathy?

The majority of patients with statin-associated immune mediated necrotizing myopathy are in need of cholesterol-lowering medications. While one can try other strategies (like diet or ezetimibe), these are usually inadequate. Therefore, I would advocate for PCSK9 inhibitors as first-line treatment, which are safe for these patients and quite effective. Unfortunately, this would have to be a battle with the insurance company given the high cost of the medication, but need to work with the PCP or cardiologist to establish how statins are absolutely contraindicated and the safety of the PCSK9i in these patients.