Lehman Bethany, Neuner Elizabeth A, Heh Victor, Isada Carlos
Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri, USA.
Open Forum Infect Dis. 2019 Nov 7;6(11):ofz444. doi: 10.1093/ofid/ofz444. eCollection 2019 Nov.
Daptomycin has been associated with increased creatine phosphokinase (CPK) due to muscle injury leading to myalgias and muscle weakness. Statins have been proven to cause the same effects and it is recommended to discontinue the use of statins while on daptomycin. Evidence regarding this drug interaction is mixed. This study evaluated the risk of CPK elevation in concomitant use of daptomycin and statins compared to daptomycin alone.
This is a multisite retrospective case-control study of patients who received daptomycin therapy with monitoring of CPK. Rates of CPK elevations were compared in patients receiving daptomycin with a statin versus daptomycin alone. To estimate the association between CPK elevation and daptomycin therapy controlling for other risk factors, logistic regression was used to analyze data. Statistical significance was determined at ɑ of 0.05.
A total of 3658 patients were included in the study, with 2787 on daptomycin therapy alone and 871 with concurrent statin use. The incidence of CPK elevation was 90 events (3.2%) in the daptomycin group and 26 events (3.0%) in the concurrent statin group. Patients who received daptomycin therapy in addition to statins had no statistically significant difference from patients on daptomycin alone (hazard ratio, 1.05; = .85; 95% confidence interval, 0.61-1.84). After adjusting for potential risk factors, the hazards ratio remained almost the same.
Concomitant use of daptomycin and statin did not show an increase risk of CPK elevation. Clinicians may consider concomitant use of daptomycin and statin therapy with weekly CPK monitoring.
达托霉素与因肌肉损伤导致的肌酸磷酸激酶（CPK）升高有关，进而引起肌痛和肌肉无力。他汀类药物已被证实会产生同样的影响，因此建议在使用达托霉素时停用他汀类药物。关于这种药物相互作用的证据并不一致。本研究评估了与单独使用达托霉素相比，联合使用达托霉素和他汀类药物时CPK升高的风险。
这是一项多中心回顾性病例对照研究，研究对象为接受达托霉素治疗并监测CPK的患者。比较接受达托霉素联合他汀类药物治疗的患者与单独接受达托霉素治疗的患者CPK升高的发生率。为了评估CPK升高与控制其他风险因素的达托霉素治疗之间的关联，采用逻辑回归分析数据。统计学显著性设定为ɑ = 0.05。
共有3658名患者纳入研究，其中2787名患者单独接受达托霉素治疗，871名患者同时使用他汀类药物。达托霉素组CPK升高的发生率为90例（3.2%），联合他汀类药物组为26例（3.0%）。除他汀类药物外还接受达托霉素治疗的患者与单独使用达托霉素的患者相比，差异无统计学意义（风险比，1.05；P = 0.85；95%置信区间，0.61 - 1.84）。在调整潜在风险因素后，风险比几乎保持不变。
联合使用达托霉素和他汀类药物并未显示出CPK升高风险增加。临床医生可以考虑联合使用达托霉素和他汀类药物治疗，并每周监测CPK。
