Medication for high cholesterol while taking Actemra infusions

I was taking high dose prednisone and Actemra to treat GCA, and my cholesterol got high enough that my primary care doctor said I would probably need to start taking a statin. He suggested retesting my cholesterol again after 3 months before making a decision about the statin. During the following 3 months I continued tapering the prednisone. I think the dose went down from 30 mg per day to about 10. When I got retested, my cholesterol had come down significantly - 33 points on the total, and 17 on the LDL I think the lower dose of prednisone caused the drop. My cholesterol came down enough that I didn't need to take a statin.

When I thought I was going to have to take a statin, I did some research. It sounded like rosuvastatin is one of the best statins for minimal side effects. I checked the interactions with Actemra, and research indicates the Actemra can reduce the effectiveness of a statin, so a higher dose of the statin might be needed. It sounds like it's safe to take a statin with Actemra.

you dont say whether your taking prednisone. Prednisone alone in the 6 months I took it raised my total cholesterol from 230 to 305. I am not sure of the side effects of actemra on cholesterol but try to get off prednisone. I have the genetic version of cholesterol . Statins are not a good alternative for me. They have many side effects. Repatha works for me. Its an epi pen injection twice a month. 2 years now with no side effects.

Sounds like you are on the right track. No, I am not on prednisone, just Actemra. Will try changing diet for 3 months before taking any statins. Thanks

Exercise can help too. I try to get an hour or more every day.

I took atorvastatin for many years. It was started shortly after being diagnosed with PMR and treated with prednisone. My cholesterol numbers "looked good" until Actemra was started and I got off prednisone.

My cholesterol numbers decreased on Actemra after Prednisone was stopped to the extent that my cholesterol levels were too low. A low cholesterol level in conjunction with an elevated CK level suggested statin induced myopathy.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8583847/
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It took a while to get sorted out but when atorvastatin was stopped my cholesterol level increased again but my CK level didn't improve. The thinking changed to prednisone induced myopathy. Since I was already off prednisone the solution was to not check my CK level anymore. My labs were being checked by my rheumatologist who couldn't explain my lab results except that they might explain some of my muscle aches and pains. I denied having any difficulty with atorvastatin when I was taking Prednisone for years.
https://www.ncbi.nlm.nih.gov/books/NBK557731/
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When I saw an endocrinologist for metabolic syndrome related to my long term Prednisone use he noted that my cholesterol level was on the "high side" again and "probably should be treated." He said coming off prednisone disrupts the equilibrium that my body was trying to maintain when I was on prednisone. He said it all because of hormone imbalances that will take time to resolve.

My endocrinologist wasn't sure what Actemra was doing but he wasn't surprised that I needed atorvastatin when I was taking prednisone. He said I was "very sensitive to statins" so I probably didn't need a statin when I was off prednisone. He said diet and exercise would help the most.

The endocrinologist suggested Zetia (ezetimibe) in lieu of restarting the statin. I have been on Zetia for about a year now. My metabolic equilibrium must have reset itself because now my cholesterol levels and CK levels are well within the normal range. The endocrinolgist is happy with my levels. He said zetia wasn't quite as strong as a statin and worked differently. He also said to keep doing what I was doing in regards to diet and exercise.
https://www.drugs.com/medical-answers/zetia-statin-3554184/

All very interesting. Glad you found the right med. I will check it out, but am not on prednisone. Thanks

Just a caution for statin drugs, of some little known side effects. I am a woman, and asked my cardiologist about my severe fatigue symptoms since coming home from a hospital visit for suspected TIA two months ago, if my starting on atorvastatin could be the cause. He said yes. Not a common side effect, but some, women in particular, have had that side effect. I had not been able to find a reason for it, and thought I must be very ill. He suggested missing a few doses to see if the symptoms lessen. They did. Now I have to find a new cholesterol drug, or try to take them a few times a week or less. Diet and exercise have not been enough.
Drugs are powerful, be careful about what you’re taking.

I have genetic cholesterol and it cant be fixed with my diet. Well Mayo Dr says cant be fixed but that's knowing the American way of eating. Statins cause me fatigue, muscle aches, and a severe IBS. I have tried every version of anything ending in "tin". They switched me to Zetia and while not as many side effects fatigue is very noticeable. Mayo switched me to Repatha. A twice a month epi pen. It will cut your LDL at least in half. Three years now with no known effects. They want my LDL less than 70 and it runs 72. (I started at 210) . They just started me on Nexletol. I take half a tablet to avoid any problems. No issues in 3 months. Both drugs are expensive without insurance. I had to switch to united health care drug coverage during open enrollment. I am on Medicare. My total cholesterol went from 240 to 320 in just 6 months on prednisone. Steroids have a definite impact. Hope this helps.

Thank you for your sharing. It does help!