IVIG Discontinuation in Resolved Statin-Induced Immune-Mediated Necrotizing Myopathy

Patient Selection and Monitoring

• The American College of Cardiology suggests that patients with resolved statin-induced immune-mediated necrotizing myopathy, who have achieved complete remission with normalized CPK levels and restored function, do not require continuation of IVIG therapy 1, 2
• Patients who have maintained remission for 3+ years with normalized CPK and full function can discontinue IVIG with close monitoring, as recommended by the American College of Cardiology 1, 2
• Monitoring plan after IVIG discontinuation includes checking CPK levels every 4-8 weeks for 6 months, then quarterly, and reporting muscle weakness, soreness, or brown urine immediately, as suggested by the American College of Cardiology 4, 5

Risk-Benefit Analysis

• Continuing IVIG in a patient with 3+ years of complete remission exposes them to infusion reactions, headaches, aseptic meningitis, renal dysfunction risk, and anaphylaxis risk, according to the American College of Cardiology 1, 2
• The American College of Cardiology recommends weighing the risks of IVIG continuation against the minimal benefit in patients with no active disease markers, excellent functional status, and low relapse rate in anti-HMGCR myopathy after achieving remission 1, 2