Fluoroquinolone Use and the Risk of Collagen-Associated Adverse Events: A Systematic Review and Meta-Analysis

Xinyu Yu, Ding-sheng Jiang, Jing Wang, Rui Wang, Taiqiang Chen, Kan Wang, Shiyi Cao () and Xiang Wei ()
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Xinyu Yu: Huazhong University of Science and Technology
Ding-sheng Jiang: Huazhong University of Science and Technology
Jing Wang: Huazhong University of Science and Technology
Rui Wang: Huazhong University of Science and Technology
Taiqiang Chen: Huazhong University of Science and Technology
Kan Wang: Huazhong University of Science and Technology
Shiyi Cao: Huazhong University of Science and Technology
Xiang Wei: Huazhong University of Science and Technology

Drug Safety, 2019, vol. 42, issue 9, No 1, 1025-1033

Abstract: Abstract Introduction It has been suggested that fluoroquinolone antibiotics increase the risk of developing collagen-associated adverse events such as aortic dissection and aortic aneurysm. These are life-threatening emergencies that need to be prevented. Objectives We performed this systematic review to clarify the association between fluoroquinolones and three collagen-associated adverse events: aortic aneurysm or aortic dissection, retinal detachment, and tendon disorders. Methods We searched PubMed, Embase, and Scopus for observational studies up to January 2019. Cohort and case–control studies were included if they reported data on the risk of collagen-related adverse events associated with fluoroquinolone exposure versus no exposure. We assessed the quality of the included studies using the Newcastle–Ottawa Scale. Effect statistics were pooled using random-effects models. Sensitivity and subgroup analyses were performed to identify any source of heterogeneity. Results After screening 2729 citations, we included 22 observational studies (12 cohort studies and ten case–control studies) with 19,207,552 participants. Current use of fluoroquinolones was significantly associated with aortic aneurysm and aortic dissection (odds ratio [OR] 2.20; 95% confidence interval [CI] 1.92–2.52), tendon disorders (OR 1.89; 95% CI 1.53–2.33), and retinal detachment (sensitivity analysis, OR 1.25; 95% CI 1.01–1.53). Past fluoroquinolone use (> 30 and ≤ 365 days) was associated with retinal detachment (OR 1.27; 95% CI 1.09–1.47). Conclusions Fluoroquinolone use incurs a risk of developing three collagen-associated diseases (aortic aneurysm or aortic dissection, retinal detachment, and tendon disorders). Patients at an increased risk of collagen-associated diseases should not use fluoroquinolones unless no other options are available.

Date: 2019
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DOI: 10.1007/s40264-019-00828-z

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