Take 80 mg Atorvastatin for Myalgia

4 Mar

Here’s a drug pamphlet with a table about side effects

The same table can be found here: https://www.rxlist.com/lipitor-drug.htm#side_effects

As you can see, for a range of conditions, the rate at which patients experience side effects is greater in the Placebo arm than in the 80 mg arm. (Also note that patients seem to experience fewer side effects in the 80 mg arm compared to the 10 mg arm.)

It turns out it is fake news. (Note the ‘regardless of causality’ phrase dropped carelessly at the end of the title of the table.) (The likely cause is that they mixed data from multiple trials.)

Here’s an excerpt from the TNT trial that compares side effects in the 10 mg arm to the 80 mg arm:

Adverse events related to treatment occurred in 406 patients in the group given 80 mg of atorvastatin, as compared with 289 patients in the group given 10 mg of atorvastatin (8.1 percent vs. 5.8 percent, P<0.001). The respective rates of discontinuation due to treatment-related adverse events were 7.2 percent and 5.3 percent (P<0.001). Treatment-related myalgia was reported by 241 patients in the group given 80 mg of atorvastatin and by 234 patients in the group given 10 mg of atorvastatin (4.8 percent and 4.7 percent, respectively; P=0.72).

From https://www.nejm.org/doi/full/10.1056/NEJMoa050461

p.s. The other compelling thing that may go under the radar is the dramatic variability of symptoms in the Placebo arm that is implied by the data. But to get to nocebo, we would need a control group.

p.p.s. Impact of statin therapy on all cause mortality:


From the TNT trial.