1953. A Multisite Review of Concomitant Use of Daptomycin and Statins and the Effect on CPK
Session: Poster Abstract Session: Antimicrobial Pharmacokinetics and Pharmacodynamics
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • IDSA poster 2016 kc.pdf (820.9 kB)
  • Background:

    Daptomycin has been associated with increased creatine phosphokinase (CPK) due to muscle injury leading to myalgias and muscle weakness. Statins have proven to cause the same effects. This study investigated the use of daptomycin and statins together to determine if there was an increased risk of CPK elevation.

    Methods:

    This is a multisite retrospective case study of patients at the Cleveland Clinic Health System who received daptomycin. Inclusion criteria were daptomycin therapy with an initial CPK and an additional follow up CPK. Patients with a baseline CPK elevation were excluded. The primary outcome was to determine if there was an increased incidence of elevated CPKs in patients receiving daptomycin plus a statin versus daptomycin alone. Secondary outcomes being incidence of myalgias, myositis, or rhabdomyolysis, and increased incidence of CPK elevations at higher doses of daptomycin therapy. 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 alpha of 0.05.

    Results:

    A total of 9542 patients on daptomycin therapy were identified, of which 201 (2.1%) were excluded because they had elevated baseline CPK values, resulting in 9341 patients used for analysis. Out of the 9341 patients on daptomycin therapy, 1659 (17.8%) received concurrent statin with daptomycin. A considerable number, 3117 (33.4%) did not have CPK ordered and were excluded. A bivariate analysis between elevated CPK and type of daptomycin therapy received showed that significantly more patients on daptomycin alone than concurrent daptomycin and statin had CPK elevation, χ2 (1) =4.58, p=0.32, odds ratio(OR)=1.60, 95% confidence interval(CI)=1.03-2.48. The multivarient OR= 0.606, 95% CI=0.383-0.959, for CPK elevation in the daptomycin therapy group alone as compared to concurrent daptomycin and statin therapy. There was no significant statistical association between daptomycin doses of 4, 6, 8, and >8 mg/kg and CPK elevation, as well no association with rhabdomyolysis or myalgias.

    Conclusion:

    In this study, there was no elevated risk of CPK elevation in the daptomycin and statin therapy group compared to daptomycin therapy alone. 

    Bethany Lehman, DO, Internal Medicine, South Pointe Hospital, Warrensville Heights, OH, Elizabeth Neuner, PharmD, Pharmacy, Cleveland Clinic, Cleveland, OH and Carlos Isada, MD, Infectious Diseases, Cleveland Clinic, Cleveland, OH

    Disclosures:

    B. Lehman, None

    E. Neuner, None

    C. Isada, None

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