Incidence, Characteristics, and Risk Factors of Drug-associated Muscle Adverse Reaction: a Retrospective Real-world Study of Inpatients

Overview

Journal Eur J Clin Pharmacol

Specialty Pharmacology

Date 2024 Mar 5

PMID 38441574

Authors

Anqi Zhao

Daihong Guo

Man Zhu

Ao Gao

Peng Li

An Fu

Affiliations

Soon will be listed here.

Abstract

Objective: To analyze the clinical characteristics, incidence, and distribution of drug-associated muscle adverse reactions (DAMAR) in real-world inpatients, to provide valuable references for clinical medication use.

Methods: We conducted an automatic retrospective monitoring of inpatients from May 1, 2022, to April 30, 2023, to collect information on adverse drug reactions (ADR) of patients and conducted subsequent analyses.

Results: Among 102,430 hospitalizations, 1106 cases of DAMARs were identified, yielding an incidence of 1.08%, including 125 cases of rhabdomyolysis at an incidence of 0.12%. Seventy-five percent of the patients experienced muscle adverse reactions within 5 days after taking medication, with a median elevated creatine kinase (CK) value of 420.4 IU/L. Risk factors of DAMAR include age ≥ 65, male sex, obesity, hypertension, hepatic and renal insufficiency, and anemia. No significant correlation was observed between the duration of surgery and CK elevation, while the surgical procedure itself had an impact. The 114 drugs associated were predominantly nervous system drugs, anti-infectives for systemic use, and cardiovascular system drugs, with levofloxacin, pregabalin, and parecoxib being the most frequently associated drugs.

Conclusion: Healthcare professionals should be vigilant with patients exhibiting the identified risk factors. Monitoring creatine kinase and related indices when using myotoxic drugs is crucial to preventing serious adverse reactions, ultimately preserving patients' quality of life.

References

Rosenson R, Baker S, Jacobson T, Kopecky S, Parker B, The National Lipid Associations Muscle Safety Expert Panel . An assessment by the Statin Muscle Safety Task Force: 2014 update. J Clin Lipidol. 2014; 8(3 Suppl):S58-71. DOI: 10.1016/j.jacl.2014.03.004. View

McMahon G, Zeng X, Waikar S . A risk prediction score for kidney failure or mortality in rhabdomyolysis. JAMA Intern Med. 2013; 173(19):1821-8. PMC: 5152583. DOI: 10.1001/jamainternmed.2013.9774. View

Newman C, Preiss D, Tobert J, Jacobson T, Page 2nd R, Goldstein L . Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. 2018; 39(2):e38-e81. DOI: 10.1161/ATV.0000000000000073. View

Kellick K, Bottorff M, Toth P, The National Lipid Associations Safety Task Force . A clinician's guide to statin drug-drug interactions. J Clin Lipidol. 2014; 8(3 Suppl):S30-46. DOI: 10.1016/j.jacl.2014.02.010. View

Janssen L, Allard N, Saris C, Keijer J, Hopman M, Timmers S . Muscle Toxicity of Drugs: When Drugs Turn Physiology into Pathophysiology. Physiol Rev. 2019; 100(2):633-672. DOI: 10.1152/physrev.00002.2019. View

Kyriakides T, Angelini C, Schaefer J, Sacconi S, Siciliano G, Vilchez J . EFNS guidelines on the diagnostic approach to pauci- or asymptomatic hyperCKemia. Eur J Neurol. 2010; 17(6):767-73. DOI: 10.1111/j.1468-1331.2010.03012.x. View

Gabow P, Kaehny W, Kelleher S . The spectrum of rhabdomyolysis. Medicine (Baltimore). 1982; 61(3):141-52. DOI: 10.1097/00005792-198205000-00002. View

Naranjo C, Busto U, Sellers E, Sandor P, Ruiz I, Roberts E . A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981; 30(2):239-45. DOI: 10.1038/clpt.1981.154. View

Guo H, Li P, Guo D, Gao A, Zhao P, Fu A . Analysis of clinical characteristics and automatic monitoring of drug-induced arrhythmias in 167,546 inpatients. Eur J Clin Pharmacol. 2023; 79(6):759-765. DOI: 10.1007/s00228-023-03492-6. View

10.

Kong X, Guo D, Liu S, Zhu Y, Yu C . Incidence, characteristics and risk factors for drug-induced liver injury in hospitalized patients: A matched case-control study. Br J Clin Pharmacol. 2021; 87(11):4304-4312. DOI: 10.1111/bcp.14847. View

11.

Ostrowski P, Bonczar M, Avram A, Lippi G, Henry B . Safety monitoring of drug-induced muscle injury and rhabdomyolysis: a biomarker-guided approach for clinical practice and drug trials. Clin Chem Lab Med. 2023; 61(10):1688-1699. DOI: 10.1515/cclm-2023-0313. View

12.

Gao Z, Liang Y, Wu Z, Qiao Y, Li M, Huang S . Prevalence of Rhabdomyolysis Following Bariatric Surgery and its Associated Risk Factors: a Meta-Analysis. Obes Surg. 2023; 33(4):990-1003. DOI: 10.1007/s11695-023-06500-x. View

13.

Melli G, Chaudhry V, Cornblath D . Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine (Baltimore). 2005; 84(6):377-385. DOI: 10.1097/01.md.0000188565.48918.41. View

14.

Grigorian A, Gabriel V, Nguyen N, Smith B, Schubl S, Borazjani B . Black Race and Body Mass Index Are Risk Factors for Rhabdomyolysis and Acute Kidney Injury in Trauma. J Invest Surg. 2018; 33(3):283-290. DOI: 10.1080/08941939.2018.1493162. View

15.

Jones J, Kirsch H, Wortmann R, Pillinger M . The causes of drug-induced muscle toxicity. Curr Opin Rheumatol. 2014; 26(6):697-703. DOI: 10.1097/BOR.0000000000000108. View

16.

Conforti A, Chiamulera C, Moretti U, Colcera S, Fumagalli G, Leone R . Musculoskeletal adverse drug reactions: a review of literature and data from ADR spontaneous reporting databases. Curr Drug Saf. 2008; 2(1):47-63. DOI: 10.2174/157488607779315516. View

17.

Carroll M, Choi H, Min S, Hwang S, Park H, Song T . Rhabdomyolysis in a patient treated with linezolid for extensively drug-resistant tuberculosis. Clin Infect Dis. 2012; 54(11):1624-7. PMC: 3404720. DOI: 10.1093/cid/cis293. View

18.

Ochs-Balcom H, Nguyen L, Ma C, Isackson P, Luzum J, Kitzmiller J . Clinical features related to statin-associated muscle symptoms. Muscle Nerve. 2018; 59(5):537-543. PMC: 6465106. DOI: 10.1002/mus.26397. View

19.

Warden B, Guyton J, Kovacs A, Durham J, Jones L, Dixon D . Assessment and management of statin-associated muscle symptoms (SAMS): A clinical perspective from the National Lipid Association. J Clin Lipidol. 2022; 17(1):19-39. DOI: 10.1016/j.jacl.2022.09.001. View

20.

Lu H, Cole S, Howe C, Westreich D . Toward a Clearer Definition of Selection Bias When Estimating Causal Effects. Epidemiology. 2022; 33(5):699-706. PMC: 9378569. DOI: 10.1097/EDE.0000000000001516. View