A Longitudinal Study of the Neurologic Safety of Acute Baclofen Use After Spinal Cord Injury

被引:22
作者
Cragg, Jacquelyn J. [1 ]
Tong, Bobo [1 ]
Jutzeler, Catherine R. [1 ,2 ]
Warner, Freda M. [1 ,2 ]
Cashman, Neil [3 ]
Geisler, Fred [4 ]
Kramer, John L. K. [1 ,2 ]
机构
[1] Univ British Columbia, Int Collaborat Repair Discoveries ICORD, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada
[2] Univ British Columbia, Sch Kinesiol, Vancouver, BC, Canada
[3] Univ British Columbia, Fac Med, Dept Med, Div Neurol, Vancouver, BC, Canada
[4] Univ Saskatchewan, Saskatoon, SK, Canada
基金
加拿大健康研究院;
关键词
spinal cord injury; baclofen; anti-spasticity; drug safety; patient-oriented research; MOTOR RECOVERY; FUNCTIONAL IMPROVEMENT; GABA(B) RECEPTORS; MULTICENTER; SPASTICITY; PROLIFERATION; GUIDELINES; MANAGEMENT; WALKING; CELLS;
D O I
10.1007/s13311-019-00713-8
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
The objective of our study was to determine whether treatment with baclofen is neurologically safe with respect to exposure during recovery from spinal cord injury. We performed a secondary longitudinal analysis of a cohort of adult patients with traumatic acute spinal cord injury. Cumulative baclofen dose was computed over the first 4 weeks following injury from concomitant medication information from a completed clinical trial. The main outcome measure was neurologic status, which was assessed over 52 weeks with "marked recovery" defined as the conversion to higher sensory and motor function. To complete the drug safety profile, drug toxicity was assessed with assays from standard blood work. Multivariable Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs). Of the cohort (n = 651), 18% (n = 115) received baclofen within 4 weeks post injury. Baclofen use was associated with higher rates of marked neurologic recovery, even after adjustment for injury severity (HR = 2.1, 95% CI 1.5-3.0 for high dose vs none). Baclofen exposure was not associated with liver or renal side effects. The use of other medications indicated for spasticity was not associated with neurological outcomes. Overall, this longitudinal analysis provides level 3 evidence on the neurologic safety of baclofen and potential beneficial effects on recovery in the early days after acute traumatic spinal cord injury. The usefulness of concomitant medication files from completed clinical trials is highlighted. We also highlight the importance of incorporating logical patient questions and neurological outcomes into research addressing drug safety.
引用
收藏
页码:858 / 867
页数:10
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