作者：Susan Jeffrey
出處：WebMD醫學新聞
September 26, 2008(猶他州鹽湖城) — 一篇新研究顯示，偶發肌萎縮性脊髓側索硬化症(ALS)病患，有許多在診斷前因為接受statin治療而發生肌肉虛弱和疼痛。
這項發現建立在之前的研究證據，認為statin治療與此病更快速惡化有關；研究所指的此一關聯侷限在偶發ALS病患。
Carolinas神經肌肉/ ALS-MDA中心主任Benjamin R. Brooks醫師在訪問中向Medscape Neurology & Neurosurgery表示，我們並不是說statin類藥物引起ALS，但是它們會加速某些病患的病程。
這項結果發表於在美國神經學會第133屆年會。
【Statin類藥物效果】
Brooks醫師表示，已知接受statin類藥物治療高膽固醇血症和高三酸甘油脂血症的病患會有肌肉疼痛、痙攣或虛弱，停止statin類藥物後即可緩解；在罕見案例中，治療引起肌肉病變或者橫紋肌溶解。
在ALS患者中，多倫多大學最近的一篇研究認為，使用statin類藥物的ALS病患比其他沒有使用此類藥物之ALS病患出現更快速的功能衰退(Zinman L 等人，Amyotroph Lateral Scler. 2008;4:223-228)。
Brooks醫師表示，法國研究有類似的發現，提出ALS病患不適合使用statin類藥物的建議；認為這是一個可以慢慢開始被所有神經肌肉執業醫師採用的標準。
如果使用statin類藥物會加速病程惡化，研究者假設，ALS病患可能會在確定診斷前而接受statin治療時發生一些反應；為此，Brooks醫師回顧240名偶發或者家族運動神經元疾病，包括ALS、原發性側索硬化症 (PLS)、免疫不佳運動神經元病變與非典型運動神經元疾病之病患在診斷前的statin使用情形。
他們報告指出，164名偶發ALS的病患中，有31人在診斷前有使用過statin類藥物，其中28名病患使用過單一種statin，11 人發生過治療相關的肌肉疼痛，且在診斷前發生虛弱情形增加的狀況，其他3名病患都使用過3種statin類藥物，每個都發生過疼痛和虛弱；所有病患中，這些現象都發生在開始statin治療後的12個月內 。
Brooks醫師表示，在18名家族ALS病患中，使用兩種statin治療的病患都沒有出現這個現象；20名PLS病患中，有1個病患使用過單一種statin，1名病患使用多種statin，這2人有出現症狀；14名免疫不佳運動神經元病變或者非典型運動神經元疾病患者中，沒有人在診斷前使用過statin類藥物。
他們檢視ALS的共病症，是否增加此現象的風險，發現偶發ALS與糖尿病或者ALS 和甲狀腺機能減退之人中，8名使用過單一種statin藥物者，有2人在ALS診斷前有過肌肉症狀，6名使用多種statin藥物者有4人如此。
Brooks醫師表示，一個可能的解釋是，ALS病患在面對statin治療環境挑戰下的基因背景，不過，他們沒有這些特殊病患的基因背景。
因此，這只是流行病學方面的論述，認為那些使用過statin類藥物而最後發生ALS的病患中，半數會於首次使用statin之後發生疼痛和虛弱，且他們通常會有ALS診斷，這或許不是一個原因，但或許會誘發疾病病程，使他們就醫於神經科醫師而得此診斷。
他指出，我認為有越來越多的人關心statin的潛在副作用，有越來越多與肌肉和認知層面有關的文獻；Statin類藥物是兩面刃，它們對一些疾病有好處，但是對其他疾病則無，所以對一些人有好處，對一些人沒有，開始使用時必須小心。
他表示，醫師處方statin類藥物必須相當注意副作用；他結論表示，整體來說，使用statin類藥物對許多人有好處且有不錯的效果。我們討論的是一群可能有statin併發症風險的人。
該研究有部份接受Muscular Dystrophy Association和Department of Veterans Affairs資助。Brooks醫師報告沒有利益衝突。
美國神經學會第133屆年會：摘要M-9。發表於2008年9月22日。
Muscle Pain and Weakness With Statin Treatment May Herald ALS
By Susan Jeffrey
Medscape Medical News
September 26, 2008 (Salt Lake City, Utah) — A new study has shown a high proportion of patients with sporadic amyotrophic lateral sclerosis (ALS) who were exposed to statin therapy prior to their diagnosis reported muscle weakness and pain associated with statin treatment.
The finding builds on evidence from previous studies suggesting that statin treatment is associated with more rapid progression of the disease. The association in this study was limited to patients with sporadic ALS.
"We're not saying that statins cause ALS, but they may accelerate the course leading to diagnosis in some patients," Benjamin R. Brooks, MD, director of the Carolinas Neuromuscular/ALS-MDA Center, in Charlotte, North Carolina, told Medscape Neurology & Neurosurgery in an interview.
The results were presented here at the American Neurological Association 133rd Annual Meeting.
Statin Effects
It is well-known that patients receiving statins to treat hypercholesterolemia and hypertriglyceridemia may have pain, cramps, or weakness in muscle that resolves when the statin is withdrawn, Dr. Brooks said. In rare instances, treatment is associated with myopathy or rhabdomyolysis.
In the setting of ALS, a recent study by researchers at the University of Toronto suggested that patients on statins had more rapid functional decline than ALS patients not on statin therapy (Zinman L et al. Amyotroph Lateral Scler. 2008;4:223-228).
Similar findings from French researchers have led these groups to recommend that statins should not be used in patients with ALS, Dr. Brooks said. "I think that's a standard that is slowly being adopted by all neuromuscular practitioners."
If statin use can accelerate disease progression, the researchers hypothesized that patients with ALS might have experienced reactions to statin therapy before their diagnosis. To examine this question, Dr. Brooks reviewed statin use prior to diagnosis in 240 patients with sporadic or familial motor neuron diseases, including ALS, primary lateral sclerosis (PLS), dysimmune motor neuropathies, and atypical motor neuron diseases.
They report that of 164 patients with sporadic ALS, 31 were exposed to statins prior to their diagnosis. Of 28 of these patients who had received a single statin, 11 had reported treatment-associated muscle pain and increased weakness prior to their diagnosis. The 3 remaining patients had each been treated with 3 statins and had reported pain and weakness with each 1. In all patients, diagnosis occurred within 12 months of these complaints related to statin treatment.
Of the 18 familial ALS patients, neither of 2 statin-treated patients showed this phenomenon, Dr. Brooks noted. Of 20 PLS patients, 1 of 2 patients who had received a single statin and 1 patient who had received treatment with multiple statins had symptoms. There was no statin use among 14 patients with dysimmune motor neuropathies or atypical motor neuron disease prior to diagnosis.
They examined comorbidities to ALS that appeared to increase the risk for this phenomenon and found that, in patients with sporadic ALS and diabetes or ALS and hypothyroid, 2 of 8 patients who had received a single statin and 4 of 6 patients who had received multiple statins had muscle symptoms prior to diagnosis of ALS.
One possible explanation for this is the genetic background of ALS patients in the face of an environmental challenge such as statin therapy, Dr. Brooks noted. However, they do not have the genetic background of these particular patients.
"So this is just an epidemiological statement saying that in those patients who were exposed to statins who eventually developed a diagnosis of ALS, half of them will have pain and weakness associated with the first exposure to the statin, and that very often leads to a diagnosis of ALS. It may not be a cause, but it may be a trigger of the disease process that leads them to go to a neurologist and get diagnosed."
"I think that more and more people are concerned about potential side effects of statins," he added, with a growing literature on muscle-specific and some cognitive issues related to treatment. "Statins are a double-edged sword. They may be good for some diseases and not other diseases, they may be good in some people and not in other people, and one has to be very careful when initiating them."
Doctors prescribing statins should pay close attention to adverse effects, he said. "Overall, the use of statins is very good and has excellent effects on a large number of people," he concluded. "We're talking about a subgroup of people who may be at risk for a relatively rare statin complication."
The study was funded in part by the Muscular Dystrophy Association and Department of Veterans Affairs. Dr. Brooks reports no conflict of interest.
American Neurological Association 133rd Annual Meeting: Abstract M-9. Presented September 22, 2008.
[ 本帖最後由 goodcat1111 於 2008-10-7 13:05 編輯 ] |
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