Risk of aortic dissection and aortic aneurysm in patients taking oral fluoroquinolone
Journal
JAMA Internal Medicine
Journal Volume
175
Journal Issue
11
Pages
1839-1847
Date Issued
2015
Author(s)
Abstract
IMPORTANCE Fluoroquinolones have been associated with collagen degradation, raising safety concerns related to more serious collagen disorders with use of these antibiotics, including aortic aneurysm and dissection. OBJECTIVE To examine the relationship between fluoroquinolone therapy and the risk of developing aortic aneurysm and dissection. DESIGN, SETTING, AND PARTICIPANTS We conducted a nested case-control analysis of 1477 case patients and 147 700 matched control cases from Taiwan's National Health Insurance Research Database (NHIRD) from among 1 million individuals longitudinally observed from January 2000 through December 2011. Cases patients were defined as those hospitalized for aortic aneurysm or dissection. One hundred control patients were matched for each case based on age and sex. EXPOSURES Current, past, or any prior-year use of fluoroquinolone. Current use was defined as a filled fluoroquinolone prescription within 60 days of the aortic aneurysm or dissection; past use refers to a filled fluoroquinolone prescription between 61 and 365 days prior to the aortic aneurysm; and any prior-year use refers to having a fluoroquinolone prescription filled for 3 or more days any time during the 1-year period before the aortic aneurysm or dissection. MAIN OUTCOMES AND MEASURES Risk of developing aortic aneurysm or dissection. RESULTS A total of 1477 individuals who experienced aortic aneurysm or dissection were matched to 147 700 controls. After propensity score adjustment, current use of fluoroquinolones was found to be associated with increased risk for aortic aneurysm or dissection (rate ratio [RR], 2.43; 95%CI, 1.83-3.22), as was past use, although this risk was attenuated (RR, 1.48; 95%CI, 1.18-1.86). Sensitivity analysis focusing on aortic aneurysm and dissection requiring surgery also demonstrated an increased risk associated with current fluoroquinolone use, but the increase was not statistically significant (propensity score-adjusted RR, 2.15; 95%CI, 0.97-4.60). CONCLUSIONS AND RELEVANCE Use of fluoroquinolones was associated with an increased risk of aortic aneurysm and dissection. While these were rare events, physicians should be aware of this possible drug safety risk associated with fluoroquinolone therapy. Copyright ?2015 American Medical Association. All rights reserved.
SDGs
Other Subjects
ciprofloxacin; enoxacin; gemifloxacin; levofloxacin; lomefloxacin; moxifloxacin; norfloxacin; ofloxacin; pefloxacin; quinoline derived antiinfective agent; sparfloxacin; antiinfective agent; quinolone derivative; aged; aorta aneurysm; aorta dissection; Article; cardiovascular risk; case control study; Charlson Comorbidity Index; controlled study; female; groups by age; human; longitudinal study; major clinical study; male; prescription; priority journal; propensity score; sex difference; Aneurysm, Dissecting; Aortic Aneurysm; chemically induced; comorbidity; drug surveillance program; hospitalization; middle aged; risk assessment; risk factor; statistics and numerical data; Taiwan; very elderly; Aged; Aged, 80 and over; Aneurysm, Dissecting; Anti-Bacterial Agents; Aortic Aneurysm; Case-Control Studies; Comorbidity; Female; Fluoroquinolones; Hospitalization; Humans; Male; Middle Aged; Pharmacovigilance; Risk Assessment; Risk Factors; Taiwan
Publisher
American Medical Association
Type
journal article