Bezafibrate-associated rhabdomyolysis in a patient with diabetic kidney disease: A case report and successful transition to tafolecimab
Yiping Zhang, Jinrong Wang, Xiaohong Xie, Wei GuRationale:
Fibrates like bezafibrate are renally excreted and can cause rhabdomyolysis in chronic kidney disease (CKD). This report describes bezafibrate-associated rhabdomyolysis in a patient with diabetic kidney disease and successful transition to tafolecimab.
Patient concerns:
Ten days after self-initiating bezafibrate (0.2 g thrice daily), a 71-year-old female patient with diabetes, hypertension, CKD, and dyslipidemia complained of fatigue, sweating, and myalgia. Tests revealed hypokalemia, renal failure (creatinine 329.3 μmol/L), and increased creatine kinase (4865 U/L).
Diagnoses:
After ruling out other causes, a peak creatine kinase of 6419 U/L (38× upper normal limit) and myalgia were used to diagnose bezafibrate-associated rhabdomyolysis.
Interventions:
The use of bezafibrate was stopped. Hepatoprotection, renal protection, bicarbonate, potassium correction, and eventually a switch to subcutaneous tafolecimab 150 mg every 2 weeks were all part of the supportive care.
Outcomes:
Myalgia went away in 6 days, and by the time of discharge, creatine kinase had returned to normal from 6419 to 54 U/L. Following tafolecimab, low-density lipoprotein cholesterol (4.18 to 2.93 mmol/L) was lower, and muscle enzymes were normal.
Lessons:
Bezafibrate may result in severe rhabdomyolysis in diabetic CKD, particularly when combined with nifedipine (a CYP3A4 inhibitor) and reduced renal clearance. Tafolecimab’s nonrenal metabolism and low myotoxicity make it a safe and efficient substitute.