Table 1 Quantitative summary of the safety outcomes with different statins
Statin/dose | Authors/publication year | Composite of rhabdomyolysis and muscle injury | Rhabdomyolysis | Muscle injury not fulfilling criteria of Rhabdomyolysis | Myalgia | Drug induced liver injury |
|---|---|---|---|---|---|---|
Simvastatin 40 mg | Abraldes 2009 [48] | 2/30 | 0/30 | 2/30 ↑CK > 2x | Muscle weakness or myalgias 1/30 | 1/30 ↑AST > 2x |
|  | Abraldes 2016 [51] | 2/70 | 2/70 (one Child B the other in Child C) | 0/70 | 0/70 | 1/70 ↑3 × liver transaminases |
| Â | Elwan 2018 [63] | 0/20 | 0/20 | 0/20 | 2/20 | 0/20 |
| Â | Pollo-Flores 2015 [49] | 0/14 | 0/14 | 0/14 | 1/14 | 0/14 ALT decreased in simvastatin group, no values provided, and did not reach significance |
|  | Pose 2019 [59] | 3/16 | 3/16 (2 Child Pugh C, 1 Child Pugh B) | 0/16 CK—mean difference vs. placebo: 1009 IU/L (208 to 1809) p = 0·014 | (muscle symptoms) 5/16 | 3/16 ↑AST or ALT > 3 × ULN AST—mean difference vs. placebo: 130 IU/L (54 to 205) p = 0.0009 ALT -mean difference vs. placebo: 61 IU/L (22 to 100) p = 0·0025 |
|  | Vijayaraghavan 2020 [50] | 3/81 | n = 3/81 (all Child Pugh C) | 0/81 | 0/81 | n = 3/81 AST/ALT > 20 × ULN (same patients as Rhabdomyolysis) |
|  | *Jha 2019 [33] (n = 65 in simvastatin group) | 0/65 | 0/65 | 0/65 | 0/65 | 0/65 |
|  | *Munoz 2019 [32] (n = 9 in simvastatin group) | 0/9 | 0/9 | 0/9 | 0/9 | 0/9 |
| Â | Munoz 2018 [44] (abstract) (Munoz 2020 [45] full article published after initial search) | 4/30 | 0/30 | 4/30 (13%) myalgia plus CK increase | 7/30 (23%) | 0/30 |
| Â | Â | Total: 14/335 (14/261 excluding*) | Total: 8/335 (8/261 excluding*) | Total: 6/335 (6/261 excluding*) | Total: 16/335 (16/261 excluding*) | Total: 8/335 (8/261 excluding*) |
Simvastatin 20 mg | Pose 2019 [59] | N/A | 0/14 | 0/14 | (muscle symptoms) 6/14 | 1/14 ↑AST and ALT > 3 × ULN |
|  | Wani 2017 [64] | N/A | 0/38 | 1/38—muscle weakness, CPK > 5X ULN with normal ALT (after 15 days of simvastatin 20 mg daily before dose titration) | 0/38 | 0/38 |
| Â | Â | N/A | Total: 0/52 | Total: 1/52 | Total: 6/52 | Total: 1/52 |
Atorvastatin 20 mg | Bishnu 2018 [42] (n = 11 for atorvastatin group) | N/A | 0/11 | 0/11 | 0/11 | 0/11 |
|  | Ghadir 2019 [53] (both intervention and control group has atorvastatin) | N/A | 0/40 | 0/40 | 0/40 | 7/40 (3/20 + 4/20) ↑ liver transaminases > 3 xULN or noncompliance were excluded from final analysis |
| Â | Â | N/A | Total: 0/51 | Total: 0/51 | Total: 0/51 | Total: 7/51 |
Pravastatin 40 mg | Jouve 2019 [52] (84.8% of participants with cirrhosis) All patients received Sorafenib | N/A | 0/155 | CK increase Grade 1–2 29/155 in Sorafenib + Pravastatin vs (30/157 in Sorafenib alone) Grade 3–4 1/155 in Sorafenib + Pravastatin vs. 0/157 in sorafenib alone | Grade 1–2 24/155 in Sorafenib + Pravastatin vs (19/157 in Sorafenib alone) Grade 3–4 3/155 in Sorafenib + Pravastatin vs. 0/157 in sorafenib alone | 0/155 |
|  | Riaño 2020 [31] (90.3% of participants with cirrhosis) All patients received Sorafenib | N/A | 0/15 | 0/15 | 0/15 | 0/15 |
| Â | Blanc 2018 [43] (Abstract) | N/A | N/A | N/A | N/A | N/A |
| Â | Â | N/A | Total: 0/170 | Total: 30/170 | Total: 27/170 | Total: 0/170 |