{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T19:33:39Z","timestamp":1776454419482,"version":"3.51.2"},"reference-count":10,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2019,8,6]],"date-time":"2019-08-06T00:00:00Z","timestamp":1565049600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006260","name":"Rheumatology Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006260","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the safety of proprotein convertase subtilisin\/kexin type 9 (PCSK9) inhibitors in patients with statin\u2010associated anti\u20133\u2010hydroxy\u20103\u2010methlyglutaryl coenzyme A reductase (anti\u2010HMGCR)\u2013positive immune\u2010mediated necrotizing myopathy (IMNM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Muscle strength was assessed in anti\u2010HMGCR\u2013positive patients at each visit before and after initiation of PCSK9 inhibitors. The trends in creatine kinase (CK) levels and serum anti\u2010HMGCR antibody titers were monitored over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 122 anti\u2010HMGCR\u2013positive patients, we identified 8 patients who were receiving PCSK9 inhibitors for hyperlipidemia. Patients were followed up for an average of 1.5 years (range 3\u201337 months), and none exhibited reduction in muscle strength. The mean \u00b1 SD CK level prior to the initiation of PCSK9 inhibitors was 956 \u00b1 1,137 IU\/liter, which was reduced to 419 \u00b1 393 IU\/liter at their last visit. Anti\u2010HMGCR antibody titers followed a similar trend. Notably, in 2 patients, the initiation of the lipid\u2010lowering medication was followed by unanticipated spontaneous clinical improvement and reduction in immunosuppression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>PCSK9 inhibitors are safe for long\u2010term use as a cholesterol\u2010lowering agent in patients with statin\u2010associated IMNM.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.40919","type":"journal-article","created":{"date-parts":[[2019,5,6]],"date-time":"2019-05-06T17:41:02Z","timestamp":1557164462000},"page":"1723-1726","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Use of Proprotein Convertase Subtilisin\/Kexin Type 9 Inhibitors in Statin\u2010Associated Immune\u2010Mediated Necrotizing Myopathy: A Case Series"],"prefix":"10.1002","volume":"71","author":[{"given":"Eleni","family":"Tiniakou","sequence":"first","affiliation":[{"name":"Johns Hopkins University School of Medicine  Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erika","family":"Rivera","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine  Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew L.","family":"Mammen","sequence":"additional","affiliation":[{"name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland, and Johns Hopkins University School of Medicine  Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Christopher\u2010Stine","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine  Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,8,6]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.27572"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.30156"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1515161"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0000000000000438"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.016080"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcp.22130"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.7150\/ijbs.3524"},{"key":"e_1_2_7_9_1","first-page":"787","article-title":"More severe disease and slower recovery in younger patients with anti\u20103\u2010hydroxy\u20103\u2010methylglutaryl\u2010coenzyme A reductase\u2010associated autoimmune myopathy","volume":"56","author":"Tiniakou E","year":"2017","journal-title":"Rheumatology (Oxford)"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.7326\/L18-0705"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2017.04.086"}],"container-title":["Arthritis &amp; Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/art.40919","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/art.40919","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/art.40919","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T20:18:59Z","timestamp":1759954739000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/art.40919"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,6]]},"references-count":10,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2019,10]]}},"alternative-id":["10.1002\/art.40919"],"URL":"https:\/\/doi.org\/10.1002\/art.40919","archive":["Portico"],"relation":{},"ISSN":["2326-5191","2326-5205"],"issn-type":[{"value":"2326-5191","type":"print"},{"value":"2326-5205","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,6]]},"assertion":[{"value":"2019-03-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-04-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-08-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}