Signals of muscle relaxant drug interactions associated with unintentional traumatic injury: A population-based screening study
Ghadeer Dawwas is a postdoctoral fellow in the Department of Epidemiology, Biostatistics and informatics at the Perelman School of Medicine of the University of Pennsylvania. Dr. Dawwas’s research focuses on the comparative effectiveness and safety of medical products in selected patients’ populations who were often excluded or underrepresented in randomized clinical trials. She received the best second abstract award from the International Society of Pharmacoepidemiology (ISPE) for her work examining the risk of cardiovascular diseases with sodium-glucose co-transporter inhibitors in patients with type 2 diabetes, one of the most read articles between 2018-2019 in Diabetes Obesity and Metabolism. Her work on the safety of apixaban, which was published in the Lancet Hematology, received the best poster award from the International Society of Pharmacoeconomics and Health Outcomes Research (ISPOR). In addition to these areas, Dr. Dawwas has investigated antiplatelet therapy in patients with acute coronary syndrome, risk of heart failure in users of dipeptidyl peptidase-4 inhibitors, and utilization of medications. In 2017, Dr. Dawwas received an American Association of University Women (AAUW) Fellowship
We examined potential associations between concomitant medications taken with muscle relaxants and hospital presentation for unintentional traumatic injury.
In a series of self-controlled case series studies, we screened 2000–2019 US Optum Clinformatics data to identify drug interaction signals for muscle relaxant + precipitant pairs and unintentional traumatic injury. We included new users of a muscle relaxant aged 16–90 years who were dispensed at least one precipitant drug and experienced an unintentional traumatic injury during continuous muscle relaxant therapy (accounting for grace periods between dispensings). We classified each observation day as precipitant-exposed or precipitant-unexposed. The outcome was an emergency department or inpatient discharge diagnosis for unintentional traumatic injury (e.g., fracture, intracranial injury). We used conditional Poisson regression to estimate rate ratios (RRs), adjusting for time-varying confounders, and accounting for multiple estimation via semi-Bayes shrinkage.
We identified 74,114 new users of muscle relaxants experiencing an unintentional traumatic injury, among whom we studied concomitant use of 2,543 muscle relaxants + precipitant pairs. Sixteen (0.6%) pairs were statistically significant and positively associated with injury and therefore deemed signals of a possible drug interaction. Adjusted RRs ranged from 1.29 (95% confidence interval: 1.04–1.62) for baclofen + sertraline to 2.28 (1.14–4.55) for methocarbamol + lamotrigine. One (6.3%) of 16 signals is currently reported in a major drug interaction knowledgebase.
Using real-world data, we identified numerous new signals of muscle relaxant drug interactions associated with unintentional traumatic injury. Future studies should seek to confirm or refute these potential interactions.
KeywordsMuscle relaxant, unintentional traumatic injury, drug interactions, pharmacoepidemiology, population health, self-controlled case series
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