Statins may be more tolerable than discontinuation rates imply

When patients are rechallenged to restart statin therapy after discontinuation for a statin-related event, long-term tolerance may be achievable, new data suggest.

Researchers studied the medical records of 107,835 patients prescribed a statin from 2000 to 2008 to determine reasons for discontinuation and the role of statin-related events.

During the 8-year study period, nearly one in five patients discontinued statin therapy for a minimum of 12 months. More than 17% of patients reported experiencing statin-related events. More than 11,000 patients discontinued statin use temporarily and, of those, 6,579 were rechallenged with a statin in the subsequent year.

Outcomes of statin rechallenge

Ninety-two percent of rechallenged patients were still taking a statin 12 months after discontinuation related to the statin-related event. The researchers assigned 2,721 patients to rechallenge with the same statin that caused a statin-related event. Among these patients, 1,295 were still taking the statin 12 months later, and 996 were receiving the same or a higher dose. Few rechallenged patients experienced another statin-related event and serious adverse reactions were rare, according to the study abstract.

Reasons for discontinuation ranged from adverse reactions and patient rejection to cost or insurance-requested changes. The most commonly reported statin-related events included myalgia or myopathy, musculoskeletal and connective tissue disorders other than myalgia or myopathy, general disorders and administration site conditions, hepatobiliary disorders, drug intolerance and gastrointestinal disorders.

“Our findings indicate that patients who had statin-related clinical events may frequently be able to tolerate statins in the long term. … Providers should consider rechallenging patients who report statin-related events to identify those who can continue taking them,” researchers wrote.

Strategies to improve statin adherence

In an accompanying editorial, Scott M. Grundy, MD, PhD, director of the Center for Human Nutrition, University of Texas Southwestern Medical Center, wrote: “Clinicians initiate statin therapy with the expectation that the patient will continue lifelong treatment. However, this is a tall order for many persons, and it is not surprising that discontinuation rates are relatively high.

“Patients stop taking statins for many reasons. … Consideration of two questions can inform strategies to improve statin adherence. First, why do patients discontinue statins? Second, in what portion of patients who discontinue statins do real side effects (statin intolerance) prevent continuation of therapy?”

For more information:

Grundy SM. Ann Intern Med. 2013;158:562-563.

Zhang H. Ann Intern Med. 2013;158:526-534.

Disclosure: The researchers report no relevant financial disclosures. Grundy reports consulting for Merck and Pfizer.