Kido Kazuhiko, Oyen Austin A, Beckmann Morgan A, Brouse Sara D
College of Pharmacy Allied Health Professions, South Dakota State University, Sioux Falls, SD.
Department of Pharmacy Practice, Avera McKennan Hospital, Sioux Falls, SD.
Am J Health Syst Pharm. 2019 Feb 1;76(4):206-210. doi: 10.1093/ajhp/zxy036.
This article evaluates the musculoskeletal safety of concomitant therapy with daptomycin and Hydroxymethylglutaryl-coenzyme A (HMG CoA) reductase inhibitors (statins).
Often indicated for severe gram-positive infections, daptomycin is commonly administered with statins but there is limited guidance on the appropriate management of concomitant therapy with daptomycin and statins. A narrative review was conducted to review contemporary clinical evidence of the safety of concomitant therapy with daptomycin and statins. A total of 5 studies were identified comparing daptomycin monotherapy versus daptomycin and statin concomitant therapy for the primary outcome of creatine phosphokinase (CPK) elevations in a variety of patient populations with systemic, skin/soft tissue, and bone/joint infections. Of these studies, 4 also compared myalgia or myopathy as a secondary outcome. Case studies, the case-control study and 1 prospective registry comparing statin alone versus daptomycin and statin concomitant therapy were excluded. These studies showed that concomitant therapy with daptomycin and statin was not significantly associated with CPK elevation or higher event rate of myalgia or myopathy, compared to daptomycin monotherapy.
Published cohort studies do not demonstrate a statistically significant difference in the rate of CPK elevations or musculoskeletal toxicities between patients receiving daptomycin monotherapy and daptomycin plus a statin. Patients receiving statins who start daptomycin therapy should continue statin but with weekly monitoring of CPK levels. Continuation of statins is especially important in high-risk patients receiving statins for secondary prevention for atherosclerotic cardiovascular diseases. If myalgia develops, it is reasonable to evaluate the degree of CPK elevation and reassess the need for statin use during daptomycin treatment.
本文评估达托霉素与羟甲基戊二酰辅酶A（HMG CoA）还原酶抑制剂（他汀类药物）联合治疗的肌肉骨骼安全性。
达托霉素常用于治疗严重革兰氏阳性菌感染，通常与他汀类药物联合使用，但关于达托霉素与他汀类药物联合治疗的适当管理的指导有限。进行了一项叙述性综述，以回顾达托霉素与他汀类药物联合治疗安全性的当代临床证据。共确定了5项研究，比较了达托霉素单药治疗与达托霉素和他汀类药物联合治疗在各种患有全身性、皮肤/软组织和骨/关节感染的患者群体中肌酸磷酸激酶（CPK）升高的主要结局。在这些研究中，4项还比较了肌痛或肌病作为次要结局。排除了病例研究、病例对照研究以及1项比较单独使用他汀类药物与达托霉素和他汀类药物联合治疗的前瞻性登记研究。这些研究表明，与达托霉素单药治疗相比，达托霉素与他汀类药物联合治疗与CPK升高或肌痛或肌病的更高发生率无显著相关性。
已发表的队列研究表明，接受达托霉素单药治疗的患者与接受达托霉素加他汀类药物治疗的患者在CPK升高率或肌肉骨骼毒性方面无统计学显著差异。开始使用达托霉素治疗的他汀类药物使用者应继续使用他汀类药物，但需每周监测CPK水平。对于接受他汀类药物进行动脉粥样硬化性心血管疾病二级预防的高危患者，继续使用他汀类药物尤为重要。如果出现肌痛，合理的做法是评估CPK升高程度，并重新评估在达托霉素治疗期间使用他汀类药物的必要性。
