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Concomitant use of statins and macrolide antibiotics and risk of serious renal events: A nationwide cohort study

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  • Marie Lund
  • Henrik Svanström
  • Björn Pasternak
  • Anders Hviid
  • Mads Melbye
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BACKGROUND: Concomitant use of statins metabolized by the cytochrome P450 isoenzyme 3A4 (CYP3A4) and CYP3A4-inhibiting macrolide antibiotics may confer an increased risk of renal failure. We investigated the risk of serious renal events associated with concomitant use of such statins and such macrolides.

METHODS: In a nationwide register-based cohort study (Denmark, 1999-2017), we identified 906,423 new users (40-79 years old), of CYP3A4-metabolized statins. In propensity score-matched analyses, we compared the risk of serious renal events during episodes of concomitant use of statins and CYP3A4-inhibiting macrolides (n = 71,521) with episodes of use of statins alone (n = 285,488) and, as the primary analysis, with episodes of concomitant use of statins and an active comparator (penicillin V, n = 139,446). Using proportional hazards regression, we estimated hazard ratios (HRs) for serious renal events within 30 days of start of follow-up.

RESULTS: We observed 25 serious renal events during concomitant use of statins and macrolides (incidence rate [IR], 4.9 per 1000 person-years). Compared with use of statins alone (50 events; IR, 2.3), concomitant use of statins and macrolides was associated with a significantly increased risk of serious renal events (HR 2.16, 95% confidence interval [CI] 1.33, 3.49). Compared with concomitant use of statins and penicillin V (52 events; IR, 5.3), however, we observed no increased risk (HR 0.93, 95% CI 0.58, 1.49).

CONCLUSIONS: In this nationwide cohort study concomitant use of statins and macrolides was not associated with a significantly increased risk of serious renal events.

Original languageEnglish
JournalInternational Journal of Cardiology
Volume269
Pages (from-to)310-316
Number of pages7
ISSN0167-5273
DOIs
Publication statusPublished - 15 Oct 2018

ID: 56299942