Link between fluoroquinolones and aortic aneurysm risk not strong, find JAMA studies

Results together from the two studies published in the JAMA Internal Medicine were not able to present a clear association between the use of fluoroquinolone antibiotics and the risk of aortic aneurysm or dissection.

A warning issued by FDA in 2018 had stated that fluoroquinolones can increase the occurrence of rare but serious ruptures or tears in the main artery of the body, called the aorta, which can lead to dangerous bleeding or even death.

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The first study led by Yaa-Hui Dong, National Yang-Ming University School of Pharmaceutical Science, Taipei, Taiwan, matched 5400 aortic aneurysm or dissection patients with 54,000 controls without the aortic disease. The cases and controls had similar infections in the prior 60 days. This led them to conclude that Fluoroquinolones versus other antibiotics did not increase aortic risk.

"Our results highlight the importance of accounting for coexisting infections while examining the safety of antibiotics using real-world data; the findings suggest that concerns about AA/AD risk should not deter fluoroquinolone use for patients with indicated infections," wrote Dong and associates.

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The second study led by Chandrasekar Gopalakrishnan, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, compared outcomes in 280,000 patients who began oral antibiotics for pneumonia and 950,000 who took them for urinary tract infections using a U.S. claims database. The study found a small increase risk for aortic disease among those taking fluoroquinolones for pneumonia (0.03% vs. 0.01% with other antibiotics) but not for urinary tract infections (less than 0.01% for both drug classes).

"The findings of this nationwide cohort study of adults with pneumonia or UTI suggest an increased relative rate of AA/AD associated with fluoroquinolones within the pneumonia cohort but not within the UTI cohort. In both cohorts, the absolute rate of AA/AD appeared to be low (<0.1%). The increased relative rate observed in the pneumonia cohort may be due to residual confounding or surveillance bias," concluded Gopalakrishnan and associates.

"The association between fluoroquinolone use and risk of aortic aneurysm or dissection remains unproven -- is the key takeaway from the two studies.

References:

1). Association of Infections and Use of Fluoroquinolones With the Risk of Aortic Aneurysm or Aortic Dissection by Dong et al. DOI: 10.1001/jamainternmed.2020.4192

2). Association of Fluoroquinolones With the Risk of Aortic Aneurysm or Aortic Dissection by Gopalakrishnan et al. DOI: 10.1001/jamainternmed.2020.4199