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Case report
Statin-induced anti-HMGCR antibody-related immune-mediated necrotising myositis achieving complete remission with rituximab
  1. Wenwen Zhang1,
  2. Henry Miles Prince2 and
  3. Katrina Reardon1
  1. 1Department of Neurology and Neurological Research, St Vincent's Hospital, Fitzroy, Victoria, Australia
  2. 2Department of Hematology, Cell Therapies, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  1. Correspondence to Dr Wenwen Zhang; dr.wenwenz{at}


Statin-induced immune-mediated necrotising myopathy (IMNM) is a rare but increasingly recognised myositis. Many cases have positive antibodies to 3-hydroxy-3-methylglutaryl coenzyme A reductase (anti-HMGCR). The current treatment is ceasing the statin, but often immunosuppressive therapy is required as the antibodies persist, causing muscle necrosis. Despite the use of immunosuppressive medications, most commonly prednisolone, methotrexate, plasma exchange and/or intravenous immunoglobulin, some patients do not respond. We report the successful treatment with rituximab therapy for three patients with IMNM with positive anti-HMGCR antibodies. All three patients with statin-induced IMNM were elderly, with a disease history of 7–9 years, and had failed several immunosuppressive agents. They responded well to rituximab (induction and maintenance) therapy. They remain in remission with no symptoms and normal creatine kinase. One patient had normalisation of anti-HMGCR antibody level, and one patient’s antibody level reduced significantly. Rituximab is an effective immunosuppressive treatment for patients with refractory IMNM.

  • neurology (drugs and medicines)
  • muscle disease
  • neuromuscular disease
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  • Contributors WZ reviewed and summarised all case files and drafted the manuscript. KR and HMP have provided medical care to all patients and provided suggestions and amendments to the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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