Kwon Oh Chan, Hong Seokchan, Ghang Byeongzu, Kim Yong-Gil, Lee Chang-Keun, Yoo Bin
Division of Rheumatology, Department of Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
Division of Rheumatology, Department of Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
Am J Med. 2017 May;130(5):583-587. doi: 10.1016/j.amjmed.2016.12.006. Epub 2017 Jan 5.
The purpose of this study was to investigate the risk of myopathy when statins are coadministered with colchicine in patients with gout.
In gout patients who received colchicine with or without statin, clinical data collected included medications and history of hypertension, chronic kidney disease, and liver cirrhosis. Myopathy was defined as the presence of muscle symptoms with elevated creatine kinase or myoglobin. Multivariate analysis was performed to identify risk factors for myopathy. Inverse probability of treatment weighting (IPTW)-adjusted analysis was used to evaluate the influence of concomitant colchicine and statin use on myopathy.
Of 674 patients, 486 received colchicine alone and 188 also received statin. The incidence of myopathy was not significantly higher in those on both drugs than in those on colchicine alone (2.7% vs 1.4%, P = .330). On multivariate analysis, chronic kidney disease (hazard ratio [HR] 29.056; 95% confidence interval [CI], 4.387-192.450; P <.001), liver cirrhosis (HR 10.676; 95% CI, 1.279-89.126; P = .029), higher colchicine dose (HR 20.960; 95% CI, 1.835-239.481; P = .014), and concomitant CYP3A4 inhibitor (HR 12.027; 95% CI, 2.743-52.725; P = .001) were associated with increased risk of myopathy. Concomitant use of statins, however, was not, even after adjusting for confounders (HR 1.123; 95% CI, 0.262-4.814; P = .875; IPTW-adjusted HR 0.321; 95% CI, 0.077-1.345; P = .120).
Concomitant use of statin and colchicine was not associated with increased risk of myopathy. Thus, concomitant use of statin with colchicine seems to be safe from myotoxicity in gout patients.
本研究旨在调查痛风患者中他汀类药物与秋水仙碱联合使用时发生肌病的风险。
在接受秋水仙碱治疗（无论是否联用他汀类药物）的痛风患者中，收集的临床数据包括用药情况以及高血压、慢性肾病和肝硬化病史。肌病定义为出现肌肉症状且肌酸激酶或肌红蛋白升高。进行多因素分析以确定肌病的危险因素。采用治疗权重逆概率（IPTW）调整分析来评估秋水仙碱与他汀类药物联合使用对肌病的影响。
674例患者中，486例仅接受秋水仙碱治疗，188例同时接受了他汀类药物治疗。两种药物联用患者的肌病发生率并不显著高于单用秋水仙碱的患者（2.7% 对1.4%，P = 0.330）。多因素分析显示，慢性肾病（风险比[HR] 29.056；95%置信区间[CI]，4.387 - 192.450；P < 0.001）、肝硬化（HR 10.676；95% CI，1.279 - 89.126；P = 0.029）、较高的秋水仙碱剂量（HR 20.960；95% CI，1.835 - 239.481；P = 0.014）以及同时使用CYP3A4抑制剂（HR 12.027；95% CI，2.743 - 52.725；P = 0.001）与肌病风险增加相关。然而，即使在调整混杂因素后，联用他汀类药物也并非如此（HR 1.123；95% CI，0.262 - 4.814；P = 0.875；IPTW调整后的HR 0.321；95% CI，0.077 - 1.345；P = 0.120）。
他汀类药物与秋水仙碱联合使用与肌病风险增加无关。因此，在痛风患者中，他汀类药物与秋水仙碱联合使用似乎不会产生肌毒性。
