Simvastatin-induced myopathy with concomitant use of cyclosporine: case report

Simvastatin has been shown to play an important role in reducing the risk of cardiovascular events caused by atherosclerosis. To promote the understanding of the potential toxicity of simvastatin and individualized treatment in genetic factors, we report a case of a renal transplant in a female patient who had developed acute myopathy after taking simvastatin.

By PCR restriction fragment length polymorphism (PCR-RFLP) and allele-specificity polymerase chain reaction (AS-PCR) and direct sequencing. The genotypes of CYP3AP1, CYP3A5, CYP3A4 and SLCO1B1 were analyzed.

The patient was identified to have mutant genotypes of CYP3AP1*3/*3 (-44G > A), CYP3A5*3/*3 (6986A > G) and wild genotype of CYP3A4*1/*1 and SLCO1B1*1/*1, which finally led to the elevation of her cyclosporine level except the SLCO1B1*1/*1 genotype and the acceleration of simvastatin-induced acute myopathy.

Genetic factors have partly contributed to the development of simvastatin-induced myopathy with concomitant use of cyclosporine, and provided information on the adverse reactions of statins. What is different from other studies is that the SNP of SLCO1B1*5 does not take part in this adverse reaction.