Statins may increase the risk of liver disease in patients with Graves orbitopathy

This study was published in the Journal of Clinical Endocrinology and Metabolism 2015 Mar 9

Study title and authors:
STATINS MAY INCREASE THE RISK OF LIVER DISFUNCTION IN PATIENTS TREATED WITH STEROIDS FOR ACTIVE GRAVES' ORBITOPATHY.

Covelli D, Vannucchi G, Campi I, Currò N, D'Ambrosio R, Maggioni M, Gianelli U, Beck-Peccoz P, Salvi M.

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/25751109

Graves' orbitopathy is an autoimmune inflammatory disorder affecting the orbit around the eye, characterized by upper eyelid retraction, lid lag, swelling, redness, conjunctivitis, and bulging eyes.

Graves' orbitopathy is often treated with methylprednisolone (an intravenous glucocorticoid). Often patients with Graves' orbitopathy and using an intravenous glucocorticoid, are also treated with statins.

This paper records the cases of two patients, (a 64 years old man and a 58 years old woman), who were prescribed methylprednisolone and concomitant administration of statins.

In the 64 year old man:
(a) After starting simvastatin and methylprednisolone he suffered from liver dysfunction. (His liver enzymes were significantly increased).
(b) He stopped taking simvastatin and methylprednisolone.
(c) He restarted methylprednisolone (but not simvastatin) and his liver enzymes returned to normal.

In the 58 year old woman:
(d) After starting rosuvastatin and methylprednisolone she suffered from liver dysfunction. (Her liver enzymes were significantly increased).
(e) She stopped taking methylprednisolone but continued rosuvastatin.
(f) Her live enzymes increased further.
(g) Three weeks later she stopped the rosuvastatin and there was a progressive normalization of her liver enzymes.

Covelli concluded: "Our study shows that statins, when concomitantly employed with methylprednisolone, may be a cause of liver dysfunction during intravenous glucocorticoid in active Graves' orbitopathy".