Fluoroquinolones and the risk of aortopathy: A systematic review and meta-analysis

Noman, Anas; Qazi, Abdul H.; Alqasrawi, Musab; Ayinde, Hakeem; Tleyjeh, Imad M.; Lindower, Paul D.; Abdulhak, Aref A. Bin

doi:10.1016/j.ijcard.2018.09.067

Cited by 30 publications

(28 citation statements)

References 15 publications

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“…analyses based on these studies indicate that fluoroquinolone is associated with a small but significantly increased risk of aortic dissection and rupture. 15,16 Results of our study are consistent with these epidemiological findings and meta-analyses, although the absolute risk increase is modest. However, there are three unique findings from our analysis:…”

Section: Re Sultssupporting

confidence: 89%

“…However, in the secondary analysis, the HR for the association with fluoroquinolone use was 1.90 (95% CI, 1.22‐2.96, P < 0.05) for aortic aneurysm but not statistically significant for aortic dissection, HR 0.93 (95% CI, 0.38 to 2.29) . Two systematic meta‐analyses based on these studies indicate that fluoroquinolone is associated with a small but significantly increased risk of aortic dissection and rupture …”

Section: Discussionmentioning

confidence: 93%

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Assessing fluoroquinolone‐associated aortic aneurysm and dissection: Data mining of the public version of the FDA adverse event reporting system

et al. 2019

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Summary Aims A recent large epidemiological study found fluoroquinolone use is associated with an increased risk of aortic aneurysm or dissection. We aimed to examine fluoroquinolone (ciprofloxacin, levofloxacin and moxifloxacin) associated aortic aneurysm or dissection through data mining of the US Food and Drug Administration Adverse Event Reporting System (FAERS). Methods Reports to the FAERS from 1 January 2004 to 31 December 2016 were analysed. Pharmacovigilance tools were used for quantitative detection of signals that is, drug‐associated adverse events, including reporting odds ratio, proportional reporting ratio, information component given by a Bayesian confidence propagation neural network and empirical Bayes geometric mean. Sensitivity analyses that limited the data by gender and adverse event date also showed similar trends. Results Based on 3721 adverse event reports, all three fluoroquinolones are associated with aortic aneurysm, and levofloxacin is associated with aortic dissection. The risk of aortic aneurysm is higher than the aortic dissection. Oral administration of fluoroquinolones is more likely to produce these adverse events. Conclusion The results obtained herein are consistent with clinical observations, suggesting the necessity for further clinical research on aortic aneurysm and dissection associated with fluoroquinolones.

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Section: Re Sultssupporting

confidence: 89%

Section: Discussionmentioning

confidence: 93%

Assessing fluoroquinolone‐associated aortic aneurysm and dissection: Data mining of the public version of the FDA adverse event reporting system

et al. 2019

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“…Four meta-analyses on this issue have been published, and we have summarized the details in Table 3. [2,7,23,24] Though the major result of our meta-analysis was consistent with that of these former meta-analyses, differences and new findings between our meta-analysis and the former studies should be noted. First, these meta-analyses included no more than five studies.…”

Section: Comparison With Other Meta-analysessupporting

confidence: 87%

“…Therefore, our metaanalysis 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: 97%

“…Aortic aneurysm and aortic dissection have high complication rates and carry a high risk of mortality, [5,6] so the FDA announced the addition of these severe side effects to the warning about fluoroquinolones on December 20, 2018. To investigate these rare but serious events, two meta-analyses evaluated the relationship between the use of fluoroquinolones and the risk of aortopathy, [2,7] but both articles had some limitations, such as the quantity of included studies. Recently, the European Commission has restricted the use of fluoroquinolones due to the possibility of permanent adverse effects.…”

Section: Introductionmentioning

confidence: 99%

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

Dai

Yang

et al. 2020

Preprint

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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

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Jung¹,

Mayet²,

Mertens³

et al. 2020

Rationelle Diagnostik Und Therapie in Der Inneren Medizin

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Fluoroquinolones and the risk of aortopathy: A systematic review and meta-analysis

Cited by 30 publications

References 15 publications

Assessing fluoroquinolone‐associated aortic aneurysm and dissection: Data mining of the public version of the FDA adverse event reporting system

Assessing fluoroquinolone‐associated aortic aneurysm and dissection: Data mining of the public version of the FDA adverse event reporting system

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

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