A Retrospective Multisite Case-Control Series of Concomitant Use of Daptomycin and Statins and the Effect on Creatine Phosphokinase.

Carlos Isada,Victor Heh,Bethany Lehman,Elizabeth A Neuner

doi:10.1093/ofid/ofz444

Carlos Isada, Victor Heh + Show 2 more

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https://doi.org/10.1093/ofid/ofz444

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Abstract

ObjectiveDaptomycin 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.MethodThis 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.ResultsA 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; P = .85; 95% confidence interval, 0.61–1.84). After adjusting for potential risk factors, the hazards ratio remained almost the same.ConclusionsConcomitant 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.

Highlights

Daptomycin is a cyclic lipopeptide bactericidal antibiotic that is used in Gram-positive infections, such as those caused by Staphylococcus aureus, including methicillin resistant Staphylococcus aureus, Streptococcus pyogenes, and vancomycin resistant Enterococcus
Patients with baseline elevated creatine phosphokinase (CPK) were excluded as the elevation would not be attributable to the addition of daptomycin and is likely due to another confounding variable
Of the 3658 patients used for final analysis, 2964 had baseline CPK, whereas 694 did not have baseline CPK but had 2 CPKs while on therapy

Summary

Introduction

Daptomycin is a cyclic lipopeptide bactericidal antibiotic that is used in Gram-positive infections, such as those caused by Staphylococcus aureus, including methicillin resistant Staphylococcus aureus, Streptococcus pyogenes, and vancomycin resistant Enterococcus. Daptomycin has been associated with an increase in creatine phosphokinase (CPK) due to muscle injury leading to myalgias and muscles weakness [1, 2]. The mechanism of muscle injury is incompletely understood. Manufacturers recommend that CPK is monitored at the beginning of therapy and at least weekly in all patients taking daptomycin [3]. 3-Hydroxy-3-methyl-glutaryl coenzyme A (CoA) reductase inhibitors, are used for cholesterol and lipid lowering by. The primary objective of this study is to determine if there is an increased incidence of elevated CPK in patients taking daptomycin plus a statin over daptomycin alone

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