Tiniakou E, et al. - In patients with statin-associated anti-HMG-CoA reductase (HMGCR) immune mediated necrotizing myopathy (IMNM), whether the administration of Protein Convertase Subtilisin/Kexin Type 9 (PCSK9) inhibitors is safe was investigated. Overall 8 of 122 anti-HMGCR positive patients received PCSK9 inhibitors for hyperlipidemia. Before the initiation of PCSK9 inhibitors, 956±1137 IU/L was the mean creatine kinase level which decreased to 419±393 IU/L at last visit. A similar trend was reported for anti-HMGCR antibody titers. An unanticipated spontaneous clinical improvement and attenuation in immunosuppression was noted after the initiation of the lipid-lowering medication in 2 patients. Overall, long term use of PCSK9 inhibitors for cholesterol lowering in statin-associated IMNM patients was safe.