Association of Fluoroquinolones With the Risk of Aortic Aneurysm or Aortic Dissection
Association of Fluoroquinolones With the Risk of Aortic Aneurysm or Aortic Dissection
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DOI：
10.1001/jamainternmed.2020.4199
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发表时间：
2020-09-08
影响因子：
39
通讯作者：
Fralick, Michael
中科院分区：
文献类型：
--
作者：
Gopalakrishnan, Chandrasekar;Bykov, Katsiaryna;Fralick, Michael
重要性以往的观察性研究表明氟喹诺酮类药物与主动脉瘤或主动脉夹层相关，但这些研究可能会受到适应症或监测偏倚的混淆。目的评估氟喹诺酮类药物与主动脉瘤或主动脉夹层（AA/AD）风险的相关性，同时考虑氟喹诺酮类药物适应症的潜在混淆和差异监测的偏倚。在一项使用美国商业索赔数据库的观察性队列研究中，确定了2个成对1：1倾向评分匹配队列：在开始氟喹诺酮或阿奇霉素治疗前3天或3天内诊断为肺炎的50岁或50岁以上患者和尿路感染（UTI）的50岁或50岁以上患者在开始使用氟喹诺酮或复方甲氧苄啶和磺胺甲恶唑前3天或更短时间内诊断。估计风险比（HR）和95% CI，控制85个基线混杂因素。在二次分析中，将接受氟喹诺酮类药物的患者与接受阿莫西林的患者进行比较，无论是否考虑基线主动脉成像，以解决抗生素使用前AA/AD检测的差异。分析了2003年1月1日至2015年9月30日数据库中的患者数据。数据分析时间为2019年7月23日至2020年7月6日。主要结局和指标治疗开始后60 d内因AA/AD住院的患者。结果倾向评分匹配后，患者特征均衡，共有279 554例患者（平均[SD]年龄，63.66 [10.93]岁; 149976例女性[53.6%]）和UTI队列中948364例患者（平均[SD]年龄，62.06 [10.33]岁; 823667例女性[86.9%]）。氟喹诺酮类引发剂（肺炎队列中n = 139 772对，UTI队列中n = 474 182对）与阿奇霉素起始者相比，AA/AD发生率增加（HR，2.57; 95% CI，1.36-4.86;发生率，氟喹诺酮类为0.03%，阿奇霉素为0.01%），但与甲氧苄啶和磺胺甲恶唑联合用药相比，发生率没有增加（HR，0.99; 95% CI，0.62-1.57;发生率，
IMPORTANCE Previous observational studies have suggested that fluoroquinolones are associated with aortic aneurysm or dissection, but these studies may be subject to confounding by indication or surveillance bias.OBJECTIVE To assess the association of fluoroquinolones with risk of aortic aneurysm or aortic dissection (AA/AD) while accounting for potential confounding by fluoroquinolone indication and bias owing to differential surveillance.DESIGN, SETTING, AND PARTICIPANTS In an observational cohort study using a US commercial claims database, 2 pairwise 1:1 propensity score-matched cohorts were identified: patients aged 50 years or older with a diagnosis of pneumonia 3 days or less before initiating treatment with a fluoroquinolone or azithromycin and patients aged 50 years or older with a urinary tract infection (UTI) diagnosis 3 days or less before initiating a fluoroquinolone or combined trimethoprim and sulfamethoxazole. Hazard ratios (HRs) and 95% CIs were estimated controlling for 85 baseline confounders. In a secondary analysis, patients receiving fluoroquinolones were compared with those receiving amoxicillin, both with and without considering baseline aortic imaging, to address differences in detection of AA/AD before antibiotic use. Data on patients within the database from January 1, 2003, through September 30, 2015, were analyzed. Data analysis was conducted from July 23, 2019, to July 6, 2020.MAIN OUTCOMES AND MEASURES Hospitalization for AA/AD occurring within 60 days following treatment initiation.RESULTS After propensity score matching, patient characteristics were well balanced, with 279 554 patients (mean [SD] age, 63.66 [10.93] years; 149 976 women [53.6%]) in the pneumonia cohort and 948 364 patients (mean [SD] age, 62.06 [10.33] years; 823 667 women [86.9%]) in the UTI cohort. Initiators of fluoroquinolones (n = 139 772 pairs in the pneumonia cohort and n = 474 182 pairs in the UTI cohort) had an increased rate of AA/AD compared with initiators of azithromycin (HR, 2.57; 95% CI, 1.36-4.86; incidence, 0.03% for fluoroquinolones vs 0.01% for azithromycin) but no increased rate compared with initiators of combined trimethoprim and sulfamethoxazole (HR, 0.99; 95% CI, 0.62-1.57; incidence,