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Myasthenia gravis following statin therapy: evidence from target trial emulation and self-controlled case series study

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Listed:
  • Wanchun Xu

    (The University of Hong Kong)

  • Vincent Ka Chun Yan

    (The University of Hong Kong)

  • Zhijuan Zhang

    (The University of Hong Kong)

  • Kwun Kei Fung

    (The University of Hong Kong)

  • Koon Ho Chan

    (The University of Hong Kong
    The University of Hong Kong)

  • Kui Kai Lau

    (The University of Hong Kong
    The University of Hong Kong)

  • Celine Sze Ling Chui

    (The University of Hong Kong
    The University of Hong Kong
    Hong Kong Science and Technology Park)

  • Francisco Tsz Tsun Lai

    (The University of Hong Kong
    The University of Hong Kong)

  • Xue Li

    (The University of Hong Kong
    The University of Hong Kong
    Hong Kong Science and Technology Park)

  • Esther Wai Yin Chan

    (The University of Hong Kong
    Hong Kong Science and Technology Park
    The University of Hong Kong-Shenzhen Hospital
    The University of Hong Kong)

  • Ian Chi Kei Wong

    (The University of Hong Kong
    Hong Kong Science and Technology Park
    Aston University
    Macau University of Science and Technology)

  • Eric Yuk Fai Wan

    (The University of Hong Kong
    The University of Hong Kong
    Hong Kong Science and Technology Park)

Abstract

Several international pharmacovigilance agencies have issued warnings regarding the potential risk of myasthenia gravis (MG) following statin therapy. Our study investigated this association using population-based electronic health records in Hong Kong. We conducted a sequence of target trial emulation (TTE) for interpersonal comparison and a self-controlled case series (SCCS) study for intrapersonal comparison. In the TTE for MG onset, the incidence rates (per 100,000 person-years) and adjusted HRs were 51.91(31.80, 84.74)[HR:6.11 (3.73, 10.01)] in month 1, 16.27(9.81, 26.99)[HR:1.92(1.15, 3.19) in months 2-4, and 15.27(9.05, 25.79)[HR:1.80(1.06, 3.04)] in months 5–7. For risk of exacerbation, the adjusted HRs were 10.69(5.48, 20.84) in month 1, 1.50(0.55, 4.06) in months 2–4, and 2.79(1.33, 5.84) in months 5–7. No increased risks were found during the subsequent 18 months. A similar pattern was observed in SCCS analysis. Our findings recommend a minimum monitoring period of approximately six months for MG symptoms for patients starting using statin.

Suggested Citation

  • Wanchun Xu & Vincent Ka Chun Yan & Zhijuan Zhang & Kwun Kei Fung & Koon Ho Chan & Kui Kai Lau & Celine Sze Ling Chui & Francisco Tsz Tsun Lai & Xue Li & Esther Wai Yin Chan & Ian Chi Kei Wong & Eric Y, 2024. "Myasthenia gravis following statin therapy: evidence from target trial emulation and self-controlled case series study," Nature Communications, Nature, vol. 15(1), pages 1-9, December.
    • Handle: RePEc:nat:natcom:v:15:y:2024:i:1:d:10.1038_s41467-024-54097-1
    DOI: 10.1038/s41467-024-54097-1
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    References listed on IDEAS

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    1. Zoe Fewell & M. A. Hernan & F. Wolfe & K. Tilling & H. Choi & J. A. C. Sterne, 2004. "Controlling for time-dependent confounding using marginal structural models," United Kingdom Stata Users' Group Meetings 2004 13, Stata Users Group.
    2. Zoe Fewell & Frederick Wolfe & Hyon Choi & Miguel A. Hernán & Kate Tilling & Jonathan A. C. Sterne, 2004. "Controlling for time-dependent confounding using marginal structural models," Stata Journal, StataCorp LP, vol. 4(4), pages 402-420, December.
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