{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T08:07:39Z","timestamp":1790755659130,"version":"4.1.0"},"reference-count":12,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,11,11]]},"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:p>Statin-induced immune-mediated necrotising myopathy (IMNM) is a rare but increasingly recognised myositis. Many cases have positive antibodies to 3-hydroxy-3-methylglutaryl coenzyme A reductase (anti-HMGCR). The current treatment is ceasing the statin, but often immunosuppressive therapy is required as the antibodies persist, causing muscle necrosis. Despite the use of immunosuppressive medications, most commonly prednisolone, methotrexate, plasma exchange and\/or intravenous immunoglobulin, some patients do not respond. We report the successful treatment with rituximab therapy for three patients with IMNM with positive anti-HMGCR antibodies. All three patients with statin-induced IMNM were elderly, with a disease history of 7\u20139 years, and had failed several immunosuppressive agents. They responded well to rituximab (induction and maintenance) therapy. They remain in remission with no symptoms and normal creatine kinase. One patient had normalisation of anti-HMGCR antibody level, and one patient\u2019s antibody level reduced significantly. Rituximab is an effective immunosuppressive treatment for patients with refractory IMNM.<\/jats:p>","DOI":"10.1136\/bcr-2019-232406","type":"journal-article","created":{"date-parts":[[2019,12,2]],"date-time":"2019-12-02T05:41:17Z","timestamp":1575265277000},"page":"e232406","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Statin-induced anti-HMGCR antibody-related immune-mediated necrotising myositis achieving complete remission with rituximab"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5226-1198","authenticated-orcid":false,"given":"Wenwen","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Neurology and Neurological Research, St Vincent's Hospital, Fitzroy, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry Miles","family":"Prince","sequence":"additional","affiliation":[{"name":"Department of Hematology, Cell Therapies, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrina","family":"Reardon","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurological Research, St Vincent's Hospital, Fitzroy, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,12,1]]},"reference":[{"key":"2025082703380110000_12.11.e232406.1","doi-asserted-by":"publisher","DOI":"10.1002\/art.27572"},{"key":"2025082703380110000_12.11.e232406.2","doi-asserted-by":"publisher","DOI":"10.1002\/art.30156"},{"key":"2025082703380110000_12.11.e232406.3","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000000028"},{"key":"2025082703380110000_12.11.e232406.4","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1097\/RHU.0000000000000497","article-title":"Statin-Associated autoimmune myopathy: a systematic review of 100 cases","volume":"23","author":"Nazir","year":"2017","journal-title":"J Clin Rheumatol"},{"key":"2025082703380110000_12.11.e232406.5","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1056\/NEJMra1515161","article-title":"Statin-Associated autoimmune myopathy","volume":"374","author":"Mammen","year":"2016","journal-title":"N Engl J Med"},{"key":"2025082703380110000_12.11.e232406.6","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1002\/mus.21486","article-title":"Immune-Mediated necrotizing myopathy associated with statins","volume":"41","author":"Grable-Esposito","year":"2010","journal-title":"Muscle Nerve"},{"key":"2025082703380110000_12.11.e232406.7","doi-asserted-by":"publisher","DOI":"10.1002\/art.34673"},{"key":"2025082703380110000_12.11.e232406.8","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1111\/imj.13575","article-title":"Statin-associated immune-mediated necrotising myopathy: a new Zealand case series showing possible overrepresentation in Pacific Islanders","volume":"48","author":"Woolley","year":"2018","journal-title":"Intern Med J"},{"key":"2025082703380110000_12.11.e232406.9","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1017\/cjn.2014.22","article-title":"Statin-associated autoimmune myopathies: a pathophysiologic spectrum","volume":"41","author":"Wu","year":"2014","journal-title":"Can. 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