Phenotype Classification for Statin-Related Myotoxicity.(SRM)

The PREDICTION-ADR consortium reported a classification for statin-induced myotoxicity at a workshop in Liverpool in 2013.

Parameters:

(1) clinical signs and symptoms

(2) laboratory (serum CK concentration, HMGCR antibodies)

Clinical	Laboratory	Phenotype	Term
none	CK < 4 times ULN	CK elevation (asymptomatic)	SRM0
mild muscle complaints	CK <= ULN	tolerable myalgias	SRM1
muscle complaints, resolve completely if statins stopped	CK < 4 times ULN	intolerable myalgia	SRM2
muscle complaints, resolve completely if statins stopped	CK 4 to 9.9 times ULN	myopathy	SRM3
muscle complaints, resolve completely if statins stopped	CK 10 to 49.9 times ULN	severe myopathy	SRM4
rhabdomyolysis with or without renal failure	CK > 10 times ULN, may be > 50 times ULN with rhabdomyolysis	rhabdomyolysis	SRM5
incomplete resoluton if statins stopped	HMGCR antibodies	autoimmune-mediated necrotizing myositis	SRM6

where:

• HMGCR = 3-hydroxy-3-methylglutaryl-coenzyme A reductase.

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