Comparative Muscle Tolerability of Different Types and Intensities of Statins: A Network Meta-Analysis of Double-Blind Randomized Controlled Trials

作者全名："Hou, Qingtao; Chen, Yuqin; Zhang, Yingxiao; Pang, Caishuang"

作者地址："[Hou, Qingtao; Zhang, Yingxiao] Chongqing Med Univ, Dept Geriatr, Affiliated Hosp 1, 1 Youyi Rd, Chongqing 400016, Peoples R China; [Chen, Yuqin] Chongqing Med Univ, Coll Basic Med, Neurosci Res Ctr, Chongqing 400016, Peoples R China; [Pang, Caishuang] Chongqing Med Univ, Chongqing 400016, Peoples R China"

通信作者："Hou, QT (通讯作者)，Chongqing Med Univ, Dept Geriatr, Affiliated Hosp 1, 1 Youyi Rd, Chongqing 400016, Peoples R China."

来源：CARDIOVASCULAR DRUGS AND THERAPY

ESI学科分类：PHARMACOLOGY & TOXICOLOGY

WOS号：WOS:000890120000001

JCR分区：Q2

影响因子：3.1

年份：2023

卷号：　

期号：　

开始页：　

结束页：　

文献类型：Article; Early Access

关键词：Lipophilicity; Muscle adverse events; Network meta-analysis; Randomized controlled trials; Statins

摘要："Purpose The benefits of statins for ischemic cardio-cerebrovascular diseases are well known. However, concerns around muscle adverse events still exist. We therefore aimed to compare the muscle safety of individual statins in adults. Methods PubMed, Embase, Cochrane Central Register of Controlled Trials and Web of Science were searched to include double-blind randomized controlled trials (RCTs) comparing one statin with another or with control treatment. Pairwise meta-analyses and network meta-analyses were undertaken with Stata 14.0 software. Relative risk (RR) with 95% confidence intervals (CIs) was adopted for each outcome. Results A total of 83 RCTs were included. In the pairwise meta-analysis, statins were significantly associated with only a slight increase in muscle symptoms compared with control (RR=1.05; 95% CI=1.01-1.09). In the drug-level network meta-analyses, no statistically significant difference was found between individual statins in the incidence of muscle symptoms, myalgia, myopathy, rhabdomyolysis, creatine kinase (CK) >10 times the upper limit of normal (ULN) or discontinuation due to muscle adverse events. In the dose-level network meta-analyses, there were no statistically significant dose-dependent effects on any outcomes except that moderate-intensity statins had a higher incidence of muscle symptoms than control (RR=1.13; 95% CI=1.01-1.27). Moderate simvastatin (RR=6.57; 95% CI=1.26-34.41) and moderate pravastatin (RR=5.96; 95% CI=1.00-35.44) had a statistically significantly higher incidence of CK >10xULN compared with moderate atorvastatin. Lipophilic statins and statins metabolized by liver cytochrome P450 3A4 were not associated with an increased risk of muscle adverse events. Conclusion Statins may be generally safe on muscle. Moderate atorvastatin may be superior to equivalent simvastatin and pravastatin in muscle tolerability."

基金机构：National Natural Science Foundation of China [81901425]

基金资助正文：This work was supported by grants from the National Natural Science Foundation of China (81901425).