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Neurologie up2date 2019; 2(01): 71-86
DOI: 10.1055/a-0794-9660
Myopathien und Neuropathien
Georg Thieme Verlag KG Stuttgart · New York

Statinassoziierte Muskelsymptome und Statinmyopathie

Ilka Schneider
,
Stephan Zierz
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Publication History

Publication Date:
08 March 2019 (online)

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Statine sind hocheffizient zur Senkung erhöhter Cholesterolwerte. Allerdings sind statinassoziierte muskuläre Symptome (SAMS) die häufigste Nebenwirkung von Statinen und der Hauptgrund für Non-Adhärenz bzw. Therapieabbruch. Kenntnis der verschiedenen Präsentationen von SAMS und der ätiologischen Einordnung von Muskelbeschwerden unter Statinmedikation sowie Schritte der Diagnostik und Therapie sind daher nicht nur für den Neurologen relevant.
Kernaussagen

  • Statinassoziierte Muskelsymptome (SAMS) sind die wichtigste Nebenwirkung von Statinen.

  • Die Symptome umfassen Hyper-CK-ämie, Myalgien und unspezifische Myopathie – selten sind lebensbedrohliche Rhabdomyolysen zu verzeichnen.

  • Die Statintherapie kann ebenfalls die Entwicklung einer immunmediierten nekrotisierenden Myopathie (IMNM) mit HMGCR-Antikörpern triggern – allerdings kann diese auch ohne vorherige Statinmedikation entstehen.

  • Für die Diagnose von SAM ist der kausale Zusammenhang von Beschwerden mit einer Statinmedikation entscheidend: Die genaue Anamnese des zeitlichen Bezugs von Beschwerden zur Statinmedikation ist daher essenziell.

  • Zur klinischen Erfassung erfolgen die Bestimmung von CK-Wert, Paresen sowie EMG und Muskel-MRT.

  • Eine Statinpause ist für die differenzialdiagnostische Abgrenzung gegenüber unspezifischen Muskelbeschwerden und anderen Myopathien hilfreich.

  • Das Risiko für SAMS hängt von der Art und Dosis der Statine sowie der Komedikation und den Begleiterkrankungen ab.

  • Therapeutisch ist oft eine Dosisreduktion oder ein Statinwechsel ausreichend, um die Beschwerden zu lindern und die Statinmedikation wieder fortsetzen zu können – nur bei sehr wenigen Patienten ist ein gänzlicher Statinverzicht nötig.

  • Der Nachweis von HMGCR-Antikörpern spricht für das Vorliegen einer immunmediierten nekrotisierenden Myopathie (IMNM) mit typischem Bild in der Muskelbiopsie und erfordert therapeutisch eine Immunsuppression.

  • Wegen der Tumorassoziation bei der IMNM sollten regelmäßige Screening-Untersuchungen stattfinden.

Schlüsselwörter

statinassoziierte Muskelbeschwerden (SAMS) - HMGCR-assoziierte immunmediierte nekrotisierende Myopathie (INMN) - Nebenwirkungen von Statinmedikation - autoimmune nekrotisierende Myopathie (NAM) - Hyperlipidämie
 

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