Fluoroquinolones and the Risk of Aortic Aneurysm or Aortic Dissection: A Systematic Review and Meta-Analysis

et al. 2020

Preprint

Background. Our aim was to determine the relationship between the use of fluoroquinolones and the risk of aortic diseases. Methods. PubMed, EMBASE and the Web of Science were searched from inception to July 6, 2019, to identify observational studies that evaluated the risk of aortic diseases associated in users of fluoroquinolones compared with nonusers or users of other antibiotics. The primary outcome was the first occurrence of aortic diseases. We used the GRADE approach to rate the strength of evidence. We used the inverse variance method random-effect model to estimate the odds ratios (ORs) with 95% CIs, and statistical heterogeneity was assessed by the I 2 statistic. Results. This meta-analysis enrolled 2,829,385 patients reported the relationship between fluoroquinolones and the risk of aortic diseases. Compared with nonusers or users of other antibiotics, users of fluoroquinolone had a significantly increased risk of aortic diseases (adjusted OR, 2.10; 95% CI, 1.65-2.68; P =.000, I 2 =16.4%). The quality of evidence was moderate, and the number needed to harm (NNH) for aortic diseases among patients was estimated to be 1301. Conclusions. The fluoroquinolone use in patients significantly increases the risk of new-onset aortic diseases. Clinicians need to pay attention to these severe adverse events when considering fluoroquinolone use. Key Words: Fluoroquinolones; aortic aneurysm; aortic dissection; meta-analysis

Section: Comparison With Other Meta-analysessupporting

confidence: 87%

Section: Comparison With Other Meta-analysesmentioning

confidence: 98%

Relationship between fluoroquinolones and the risk of aortic diseases: a meta-analysis of observational studies

et al. 2020

Preprint

“…Therefore, we suggest that the result was robust. Moreover, we reevaluated the NNH for aortic aneurysm or dissection because we also found that the study by Lee et al [18] had a more statistically significant RR than the pooled results in the two previous meta-analyses [7,24]. Finally, after adjusting the data, we revaluated the quality of the evidence for the primary outcome to help medical care providers make clinical decisions.…”

Section: Comparison With Other Meta-analysesmentioning

confidence: 97%

“…Therefore, our meta-analysis is the most up-to-date and the broadest analysis; our analysis consolidates the results of the former meta-analyses. Second, we found that three of these meta-analyses used the HR of aortic aneurysm to replace the HR of aortic diseases [7,23,24]; this may underestimate the risk of occurrence of aortic diseases. We excluded this study, [19] when pooling the ORs.…”

Section: Comparison With Other Meta-analysesmentioning

confidence: 98%

Relationship between fluoroquinolones and the risk of aortic diseases: a meta-analysis of observational studies

Ma³

et al. 2020

BMC Cardiovasc Disord

Background: Our aim was to determine the relationship between the use of fluoroquinolones and the risk of aortic diseases. Methods: PubMed, EMBASE and the Web of Science were searched from inception to July 6, 2019, to identify observational studies that evaluated the risk of aortic diseases associated in users of fluoroquinolones compared with nonusers or users of other antibiotics. The primary outcome was the first occurrence of aortic diseases. We used the GRADE approach to rate the strength of evidence. We used the inverse variance method random-effect model to estimate the odds ratios (ORs) with 95% CIs, and statistical heterogeneity was assessed by the I 2 statistic. Results: This meta-analysis enrolled 2,829,385 patients reported the relationship between fluoroquinolones and the risk of aortic diseases. Compared with nonusers or users of other antibiotics, users of fluoroquinolone had a significantly increased risk of aortic diseases (adjusted OR, 2.10; 95% CI, 1.65-2.68; P = .000, I 2 = 16.4%). The quality of evidence was moderate, and the number needed to harm (NNH) for aortic diseases among patients was estimated to be 1301. Conclusions: The fluoroquinolone use in patients significantly increases the risk of new-onset aortic diseases. Clinicians need to pay attention to these severe adverse events when considering fluoroquinolone use.

“…So our meta-analysis was the up-to-date and the broadest one and can consolidate the results of former meta-analyses. Secondly, we found that three of these meta-analyses used the HR of aortic aneurysm replaced the HR of aortic diseases; [7,22,23] it may reduce the risk of occurrence of aortic diseases. We excluded this study, [18] when combing with the OR together.…”

Section: Comparison With Other Meta-analysesmentioning

confidence: 98%

Relationship between fluoroquinolones and the risk of aortic diseases: a meta-analysis of observational studies

et al. 2019

Preprint

Background Our aim was to find possible risk associated between fluoroquinolones and aortic diseases.Methods PubMed, Embase and the Web of Science were searched from inception to July 6, 2019 to identify observational studies that evaluated the risk for aortic diseases associated with users of fluoroquinolones compared with non-users or users of other antibiotics. Primary outcome was the first occurrence of aortic diseases. We used Newcastle Ottawa Scale to assess quality among cohort and case-control studies and the GRADE approach was used for rating strength of evidence and used inverse variance method random-effect model to estimate odds risks (ORs) with 95% CIs and statistical heterogeneity were assessed by the I 2 statistic.Results Five observational studies that enrolled 2,829,385 patients were reported the relationship between fluoroquinolones and the risk for aortic diseases. Compared with non-users or users of other antibiotics, current fluoroquinolone use had association with a significantly increased risk of occurrence of aortic diseases (adjusted OR, 2.15; 95% CI, 1.66-2.64; P=.000). The risk of past fluoroquinolone use remained high in aortic dissection (adjusted OR, 1.98; 95% CI, 0.97-2.99; P=.000) and aortic aneurysm (adjusted OR, 1.77; 95% CI, 0.98-2.57; P=.000). The quality of evidence was moderate and the Number Need to Treat to Harm (NNTH) for aortic diseases among elderly patients above the age of 50 were current users of fluoroquinolones was estimated to be 1245.Conclusions The current fluoroquinolones use within elderly patients significantly increased the risk for the first occurrence of aortic diseases. Clinicians need to pay attention to these severe adverse events when considering fluoroquinolone use.