Study examines fluoroquinolone use with risk of development of aortic aneurysm

Jan. 8, 2021

A new study found that fluoroquinolones were associated with increased incidence of aortic aneurysm formation in US adults, according to an article published in JAMA Surgery. This association was consistent across adults aged 35 years or older, sex, and comorbidities, suggesting fluoroquinolone use should be pursued with caution in all adults, not just in high-risk individuals.

This cohort study of 4,596,545 antibiotic prescription fills among US adults aged 18 to 64 years found an increased rate of aortic aneurysms within 90 days after fluoroquinolone use compared with alternative antibiotic use, and when stratified by age, an increased incidence of aneurysms was observed in adults 35 years or older. No differences were seen when stratifying by sex and common comorbidities (e.g., hypertension and hyperlipidemia); rather, the association of fluoroquinolone use with the aneurysm rate was consistent, suggesting a risk of drug class among both healthy and unhealthy individuals.

The results of this study suggested that fluoroquinolones should be used with caution among individuals aged 35 years or older, regardless of sex or comorbidities. Although fluoroquinolones are commonly prescribed antibiotics in the US, recent international studies have shown an increased risk of aortic aneurysm and dissection after fluoroquinolone use, leading to US Food and Drug Administration warnings limiting use for high-risk patients. It is unclear whether these data are true for the US population and who is truly high risk.

Prescription fills for fluoroquinolones or a comparator antibiotic from 2005 to 2017 among commercially insured individuals aged 18 to 64 years were identified in this retrospective analysis of MarketScan health insurance claims. This cohort study included 27,827, 254 US adults (47,596,545 antibiotic episodes), aged 18 to 64 years, with no known previous aortic aneurysm or dissection, no recent antibiotic exposure, and no recent hospitalization.

The 90-day incidence of aortic aneurysm and dissection. Inverse probability of treatment weighting in Cox regression was used to estimate the association between fluoroquinolone fill and 90-day aneurysm incidence. Interaction terms were used to assess the association of known risk factors (i.e., sex, age, and comorbidities) with aneurysm after fluoroquinolone use. Data analysis was performed March 2019 to May 2020.

JAMA Network has the article.