Myasthenia gravis following statin therapy: evidence from target trial emulation and self-controlled case series study

Wanchun Xu, Vincent Ka Chun Yan, Zhijuan Zhang, Kwun Kei Fung, Koon Ho Chan, Kui Kai Lau, Celine Sze Ling Chui, Francisco Tsz Tsun Lai, Xue Li, Esther Wai Yin Chan, Ian Chi Kei Wong and Eric Yuk Fai Wan ()
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Wanchun Xu: The University of Hong Kong
Vincent Ka Chun Yan: The University of Hong Kong
Zhijuan Zhang: The University of Hong Kong
Kwun Kei Fung: The University of Hong Kong
Koon Ho Chan: The University of Hong Kong
Kui Kai Lau: The University of Hong Kong
Celine Sze Ling Chui: The University of Hong Kong
Francisco Tsz Tsun Lai: The University of Hong Kong
Xue Li: The University of Hong Kong
Esther Wai Yin Chan: The University of Hong Kong
Ian Chi Kei Wong: The University of Hong Kong
Eric Yuk Fai Wan: The University of Hong Kong

Nature Communications, 2024, vol. 15, issue 1, 1-9

Abstract: Abstract Several international pharmacovigilance agencies have issued warnings regarding the potential risk of myasthenia gravis (MG) following statin therapy. Our study investigated this association using population-based electronic health records in Hong Kong. We conducted a sequence of target trial emulation (TTE) for interpersonal comparison and a self-controlled case series (SCCS) study for intrapersonal comparison. In the TTE for MG onset, the incidence rates (per 100,000 person-years) and adjusted HRs were 51.91(31.80, 84.74)[HR:6.11 (3.73, 10.01)] in month 1, 16.27(9.81, 26.99)[HR:1.92(1.15, 3.19) in months 2-4, and 15.27(9.05, 25.79)[HR:1.80(1.06, 3.04)] in months 5–7. For risk of exacerbation, the adjusted HRs were 10.69(5.48, 20.84) in month 1, 1.50(0.55, 4.06) in months 2–4, and 2.79(1.33, 5.84) in months 5–7. No increased risks were found during the subsequent 18 months. A similar pattern was observed in SCCS analysis. Our findings recommend a minimum monitoring period of approximately six months for MG symptoms for patients starting using statin.

Date: 2024
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DOI: 10.1038/s41467-024-54097-1

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