Safety of baclofen versus tizanidine for older adults with musculoskeletal pain.

Autor: Su Zhang VR; Department of Ambulatory Care Pharmacy, Kaiser Permanente, San Rafael, California, USA., Niu F; Pharmacy Outcomes Research Group, Kaiser Permanente, Downey, California, USA., Lee EA; Department of Internal Medicine, Southern California Permanente Medical Group, West Los Angeles, California, USA., DiStasio C; Department of Neurology, Southern California Permanente Medical Group, Harbor City, California, USA., Broder BI; Department of Research & Evaluation, Southern California Permanente Medical Group, Pasadena, California, USA., Steinberg SG; Department of Family Medicine, Southern California Permanente Medical Group, Panorama City, California, USA., Hui RL; Pharmacy Outcomes Research Group, Kaiser Permanente, Oakland, California, USA.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2023 Aug; Vol. 71 (8), pp. 2579-2584. Date of Electronic Publication: 2023 Mar 29.
DOI: 10.1111/jgs.18349
Abstrakt: Background: Baclofen and tizanidine are both muscle relaxants that carry the risk for neuropsychiatric events in older adults but there is a lack of data directly comparing their safety. This study aimed to investigate the relative risk between these two medications in causing injury and delirium in older adults.
Methods: This was a retrospective cohort study that was completed in an integrated healthcare system in the United States and included patients aged 65 years or older who started baclofen or tizanidine for the treatment of musculoskeletal pain from January 2016 through December 2018. Outcomes included new incidence of injury (concussion, contusion, dislocation, fall, fracture, or other injuries) and delirium. The cohort was followed from the initiation of therapy until the first occurrence of any of the following events: end of the index drug exposure, end of health plan membership, death, or the study end date of December 31st, 2019. Descriptive statistics were used to compare baseline patient characteristics between baclofen and tizanidine treatment groups. Cox proportional hazards model was used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals.
Results: The final study cohort included 12,101 and 6,027 older adults in the baclofen and tizanidine group respectively (mean age 72.2 ± 6.2 years old, 59% female). Older adults newly started on baclofen had a greater risk of injury (HR = 1.54, 95% CI = 1.21-1.96, P = < 0.001) and delirium (HR = 3.33, 95% CI = 2.11-5.26, p = <0.001) compared to those started on tizanidine.
Conclusion: The results of this study suggest that baclofen is associated with higher incidences of injury and delirium compared to tizanidine when used for the treatment of musculoskeletal pain. Future studies should investigate if these risks are dose-related and include a comparison group not exposed to either drug.
(© 2023 The American Geriatrics Society.)
Databáze: MEDLINE
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