Patients taking muscle relaxants at elevated risk of COPD exacerbation, unravels research

A new study published in the Chest Journal found that individuals using methocarbamol or cyclobenzaprine were more likely to experience exacerbations of their chronic obstructive pulmonary disease (COPD). In accordance with recent data, using gabapentinoids (pregabalin and gabapentin) may increase the frequency and severity of exacerbations of chronic obstructive pulmonary disease. Therefore, Irakli Lemonjava and her colleagues set out to look into any possible links between exacerbations of COPD and regularly prescribed muscle relaxants like methocarbamol and cyclobenzaprine.

The patients over the age of 18 who were diagnosed with COPD after January 1, 2000 were included in the study. They were divided into two groups where Group A consisted of patients taking either methocarbamol or cyclobenzaprine, and Group B consisted of patients not taking either of these drugs. This study focused on COPD exacerbations that occurred 1, 3, and 5 years after the index event and were classified by the international classification of diseases code J44.1.

The first day that a patient met all the chosen criteria, such as receiving a diagnosis of COPD and starting a medicine of interest, was considered the index event for that patient. Analysis did not include patients whose results occurred prior to the study timeframe. In order to account for demographic factors and ten different organ system illnesses, including the ones affecting the cardiovascular and pulmonary systems, the study used propensity score matching. Following propensity score matching, there were 399,886 people in Group A and 429,743 people in Group B.

COPD exacerbation occurred in 21,922 (5.482%) of Group A patients at 1-year follow-up, while it occurred in 21,513 (5.006%) of Group B patients, representing a 9.5% relative risk increase. At 3- and 5-year follow-ups, the risk gradually rose to 17.6% and 20.2%, respectively. At the 1-, 3-, and 5-year follow-up periods, the relative risk increase for COPD exacerbations was 9.5%, 17.6%, and 20.2% for patients on cyclobenzaprine or methocarbamol, respectively.

The warning range for the use of central nervous system depressing medicines among patients with COPD is expanded by the possibility of an increased risk of exacerbation linked to the use of routinely prescribed muscle relaxant pharmaceuticals. Thereby, physicians should weigh the possible danger of exacerbating COPD against the purported therapeutic advantages of these muscle relaxants. Alternative forms of therapy have to be taken into account.

Reference:

LEMONJAVA, I., GUDUSHAURI, N., MARTINEZ MANZANO, J. M., & AZMAIPARASHVILI, Z. (2024). EXPLORING THE ASSOCIATION BETWEEN ELEVATED COPD EXACERBATION RISK AND COMMONLY PRESCRIBED MUSCLE RELAXANTS. In CHEST (Vol. 166, Issue 4, p. A4691). Elsevier BV. https://doi.org/10.1016/j.chest.2024.06.2827