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  • Risk of hospitalized rhabdomyolysis associated with lipid-lowering drugs in a real-world clinical setting.

Risk of hospitalized rhabdomyolysis associated with lipid-lowering drugs in a real-world clinical setting.

Journal of clinical lipidology (2013-02-19)
Mark J Cziraky, Vincent J Willey, James M McKenney, Siddhesh A Kamat, Maxine D Fisher, John R Guyton, Terry A Jacobson, Michael H Davidson
ABSTRACT

The occurrence of low rates of rhabdomyolysis among patients receiving lipid-lowering drugs (LLDs) in randomized clinical trials may be elucidated with population-based studies. To determine the risk of hospitalized rhabdomyolysis associated with LLD therapy. This observational study used claims data from 9 million members of five United States health plans to identify patients (≥18 years) who received >2 statin and nonstatin LLDs during July 2000 to December 2004. Inpatient International Classification of Diseases, Ninth Revision, Clinical Modification, codes for rhabdomyolysis (791.3, 728.89, and 728.88) were observed during the follow-up period; cases were confirmed with patients' medical records. Rhabdomyolysis events were reported per 10,000 person-years of LLD exposure; multivariate analysis was conducted. The study cohort (N = 473,343) received 490,988 and 11,624 person-years of LLD, and combination therapy, respectively. Medical charts were obtained for 104 of 144 eligible patients with rhabdomyolysis claims; 42 cases were confirmed. With atorvastatin as reference, rhabdomyolysis rates (95% confidence interval) were greatest for cerivastatin, 8.4 (2.3-21.7); no difference among available statins was observed. Rates for other LLD monotherapies were: niacin, 2.1 (0.3-7.7), ezetimibe, 2.1 (0.3-7.8), fenofibrate, 0 (0-1.7), and gemfibrozil, 2.0 (0.5-5.2). Multivariate analysis showed only cerivastatin with a significantly greater risk of rhabdomyolysis (odds ratio 4.74, 95% confidence interval 1.1-21.2, P = .041) versus atorvastatin among the statins. Combination therapies had increased rhabdomyolysis risk (OR 7.1, 1.6-31.6, P = .010) versus LLDs alone. The risk of habdomyolysis among hospitalized patients receiving statins was low; no difference among the available statins was evident. Further data are needed to establish the risk profile but current findings already offer guidance to physicians.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Gemfibrozil
Supelco
Gemfibrozil, Pharmaceutical Secondary Standard; Certified Reference Material
Gemfibrozil, European Pharmacopoeia (EP) Reference Standard
Gemfibrozil for system suitability, European Pharmacopoeia (EP) Reference Standard
Supelco
Nicotinic acid, analytical standard
Fenofibrate, European Pharmacopoeia (EP) Reference Standard
Sigma-Aldrich
Nicotinic acid sodium salt, 98%
Sigma-Aldrich
Nicotinic acid, BioReagent, suitable for cell culture, suitable for insect cell culture, suitable for plant cell culture, ≥98%
Sigma-Aldrich
Nicotinic acid, ≥98%
Sigma-Aldrich
Nicotinic acid, meets USP testing specifications
Sigma-Aldrich
Fenofibrate, ≥99%, powder
Supelco
Fenofibrate, Pharmaceutical Secondary Standard; Certified Reference Material
Sigma-Aldrich
Nicotinic acid, ≥99.5% (HPLC)
Supelco
Niacin (Nicotinic Acid), Pharmaceutical Secondary Standard; Certified Reference Material