Abstract
Background: Conflicting clinical evidence and prescribing recommendations exist regarding the safety of daptomycin when coadministered with statin medications. In addition, recommendations to hold statins during daptomycin therapy do not account for atherosclerotic cardiovascular disease (ASCVD) risk. Because of this, the practice of holding or continuing statins during daptomycin therapy is variable among providers. Objectives: This study aimed to compare the musculoskeletal and cardiovascular safety of daptomycin and statin coadministration versus monotherapy and assess the appropriateness of monitoring during daptomycin infusion therapy, including creatine kinase (CK) and musculoskeletal symptoms, and the resumption of statins held during daptomycin therapy. Methods: This retrospective cohort study included patients who were prescribed a statin medication and daptomycin therapy. The primary outcome was to compare daptomycin discontinuation owing to suspected musculoskeletal toxicity between patients who had their statin held and received daptomycin monotherapy (monotherapy group) and those who received daptomycin coadministered with statins (coadministered group). Secondary outcomes included evaluating CK monitoring practices, ASCVD events, and the resumption of held statins at the completion of daptomycin therapy. Results: A total of 74 patients were included (monotherapy, n = 64; coadministered, n = 10). No statistically significant differences were observed between the 2 groups regarding daptomycin discontinuation owing to suspected musculoskeletal toxicity (6.3% monotherapy vs. 10% coadministered, P = 0.527). One patient in the monotherapy group had an ASCVD event during daptomycin therapy; none occurred within the coadministered group. Within the monotherapy group, 9 patients (14.1%) did not have documentation of statin resumption and 22 (34.4%) saw a delay of 4 or more weeks in statin resumption after daptomycin completion. Conclusion: Patients who received daptomycin coadministration with statin therapy did not experience more musculoskeletal toxicity than patients who received daptomycin monotherapy. Owing to the risk of ASCVD events and potential for errors and delays in resumption, statins should be continued during daptomycin therapy, especially in high-risk patients.