Inpatient Insights
APhA Staff
Researchers evaluate safety of daptomycin coadministered with statins
Conflicting clinical evidence and prescribing recommendations exist regarding the safety of daptomycin when coadministered with statins. Because recommendations to hold statins during daptomycin therapy do not account for atherosclerotic cardiovascular disease (ASCVD) risk, the practice of holding or continuing statins during daptomycin therapy is variable among providers. Researchers from Trinity Health Grand Rapids, MI, conducted a retrospective cohort study to compare the musculoskeletal and cardiovascular safety of daptomycin and statin coadministration versus monotherapy and assess appropriateness of monitoring during daptomycin infusion therapy, as well as the resumption of statins held during daptomycin therapy.
The study, published on June 6, 2025, in JAPhA Pharmacotherapy, included 74 patients who were prescribed a statin medication and daptomycin therapy. The primary outcome was to compare discontinuation of daptomycin due to suspected musculoskeletal toxicity between patients who had their statin held and received daptomycin monotherapy (monotherapy group) versus those who received daptomycin coadministered with statins (coadministered group). Secondary outcomes included evaluating creatinine kinase monitoring practices, ASCVD events, and the resumption of held statins at the completion of daptomycin therapy.
No significant differences were observed between the two groups regarding discontinuation of daptomycin due to suspected musculoskeletal toxicity. One patient in the monotherapy group had an ASCVD event during daptomycin therapy; none occurred within the coadministered group. Within the monotherapy group, 14.1% of patients did not have documentation of statin resumption and 34.4% saw a delay of 4 or more weeks in statin resumption after daptomycin completion. The authors concluded that due 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. ■
Does metformin provide a renal protective effect in patients with T2D?
Inhibiting the development and progression of diabetic kidney disease is an important issue, but the renoprotective effect of metformin remains controversial. A group of researchers from Taiwan sought to assess whether metformin provides a renoprotective effect by conducting a retrospective observational multicenter cohort study. Primary outcomes were doubling of serum creatinine, eGFR ≤15 mL/min/1.73 m2, and end-stage kidney disease. The study was published in the May 2025 issue of The Journal of Clinical Endocrinology & Metabolism.
The study involved more than 26,000 patients with T2D from seven hospitals. After matching for age, gender, medical year, baseline eGFR, urine protein (dipstick), and A1C, a total of 13,096 patients received metformin and 13,096 patients did not receive metformin.
After conducting a multivariable logistic regression analysis, patients in the metformin group were revealed to have better renal outcomes than those in the nonmetformin group, including a lower incidence of doubling of serum creatinine, an eGFR ≤15 mL/min/1.73 m2, and risk of end-stage kidney disease. The subgroup analyses revealed a consistent renoprotective effect across patients with various renal functions. Furthermore, when considering factors such as age, sex, comorbidities, and medications in subgroup analyses, the data consistently showed that the patients who received metformin experienced a slower deterioration in renal function across nearly all patient subgroups. ■
Which oral anticoagulant is associated with lower risk of bleeding and hospitalization for patients with VTE?
In recent years, direct oral anticoagulants (DOACs) have replaced warfarin as the medication of choice for preventing venous thromboembolism (VTE) recurrence. In a head-to head comparison, researchers from Harvard Medical School, Harvard Pilgrim Health Care Institute, and the Hinda and Arthur Marcus Institute for Aging Research (all in Boston) compared the effectiveness and safety of three common oral anticoagulants (apixaban, rivaroxaban, and warfarin) in patients with VTE.
The population-based cohort study, published online on May 12, 2025, in JAMA Internal Medicine, used Medicare and two commercial insurance databases from 2016 to 2024 to identify adult patients who initiated an oral anticoagulant and had at least 1 year of continuous insurance enrollment before the index date. The primary effectiveness outcome was hospitalization for recurrent VTE, while the primary safety outcome was major bleeding. Patients were followed up from treatment initiation until outcome occurrence, treatment discontinuation/switch, disenrollment, death, or end of available data.
Results of the study, which included more than 163,000 patients, indicated that apixaban was associated with a lower risk of hospitalizations for recurrent VTE and major bleeding compared with rivaroxaban or warfarin. While no differences in major bleeding were observed, rivaroxaban was associated with a lower risk of recurrent VTE compared with warfarin.
These findings were consistent across subgroups defined by age, sex, cancer, CKD, bleeding history, and frailty. The authors suggest that their results support the guideline recommendation to use DOACs as a primary treatment option for patients with VTE. ■
Tirzepatide may provide better weight control than semaglutide
Tirzepatide, a long-acting glucose-dependent insulinotropic polypeptide and GLP-1 receptor agonist, and semaglutide, a long-acting GLP-1 receptor agonist, are both highly effective medications for obesity management. However, the efficacy and safety of tirzepatide as compared with semaglutide in adults with obesity but without T2D is unknown. The SURMOUNT-5 Trial Investigators, led by Louis J. Aronne, MD, of Weill Cornell Medicine, conducted a phase 3b, open-label, controlled trial involving adult patients with obesity but without T2D.
A total of 751 patients were randomly assigned in a 1:1 ratio to receive the maximum tolerated dose of tirzepatide (10 mg or 15 mg) or the maximum tolerated dose of semaglutide (1.7 mg or 2.4 mg) subcutaneously once weekly for 72 weeks. The primary end point was the percent change in weight from baseline to week 72. Key secondary end points included weight reductions of at least 10%, 15%, 20%, and 25% and a change in waist circumference from baseline to week 72.
Results of the study, published on May 11, 2025, in NEJM, showed that the least-squares mean percent change in weight at week 72 was −20.2% with tirzepatide and −13.7% with semaglutide. The least-squares mean change in waist circumference was −18.4 cm with tirzepatide and −13.0 cm with semaglutide. Participants in the tirzepatide group were more likely than those in the semaglutide group to have weight reductions of at least 10%, 15%, 20%, and 25%. In both treatment groups, the weight reduction was approximately 6% greater among women than among men. The authors reported that most common adverse events in both treatment groups were GI-related and that most were mild to moderate in severity and occurred primarily during dose escalation. ■