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@ARTICLE{Wicherski:279053,
author = {Wicherski, Julia and Peltner, Jonas and Becker, Cornelia
and Schüssel, Katrin and Brückner, Gabriela and
Schlotmann, Andreas and Schröder, Helmut and Kern, Winfried
V and Haenisch, Britta},
title = {{F}luoroquinolones and the risk of aortic aneurysm or
dissection: {A} population-based propensity score-matched
{G}erman cohort study.},
journal = {Pharmacotherapy},
volume = {45},
number = {6},
issn = {0277-0008},
address = {Hoboken, NJ},
publisher = {Wiley-Blackwell},
reportid = {DZNE-2025-00683},
pages = {314 - 323},
year = {2025},
abstract = {To investigate the risk of aortic aneurysm or dissection
associated with fluoroquinolone (FQ) prescription compared
to macrolides in German routine health care data in order to
replicate the recent study (Pharmacotherapy 2023;43:883)
extending the results by contributing evidence for six
additional broad-spectrum antibiotic classes as active
comparators.Cohort study in active comparator new user
design comparing FQ with macrolides, tetracyclines,
penicillins with extended spectrum, penicillins and
beta-lactamase inhibitor combinations, second- and
third-generation cephalosporins, sulfonamide and
trimethoprim combinations, and lincosamides.German statutory
health insurance, the 'Allgemeine Ortskrankenkasse' (AOK),
January 2013 to December 2019.Adults with at least one new
prescription fill for FQ or active comparator antibiotics.
New users were defined as individuals without antibiotic
prescription fills, aortic aneurysm or dissection diagnoses,
and hospitalization within 365 days prior to the cohort
entry date. Users of FQ and active comparators were matched
by nearest neighbor 1:1 propensity score matching.Incident
inpatient aortic aneurysm or dissection was observed within
a 60-day risk window. In sensitivity analyses, an extended
risk window of 90 days was applied, and specific FQ agents,
dosages, and diagnoses were stratified.FQ episodes were
associated with an increased risk for aortic aneurysm or
dissection compared to macrolides (aHR = 1.52 [1.33; 1.74]),
which replicates the risk estimate of Garg et al. (aHR =
1.34 [1.17; 1.54]). This association was robust in a 90-day
risk window and for ciprofloxacin, levofloxacin, and
moxifloxacin. Moxifloxacin comprised the greatest risk of
aortic aneurysm or dissection compared to macrolides (aHR =
2.13 [1.64; 2.77]). Moreover, we observed similar
associations when comparing FQ to tetracyclines, penicillins
with extended spectrum, cephalosporins, and lincosamides
(aHR = 1.86 [1.54; 2.24], aHR = 1.45 [1.28; 1.65], aHR =
1.23 [1.10; 1.37], and aHR = 1.73 [1.43; 2.11]),
respectively.In a German cohort study, FQ use was associated
with a $52\%$ increased risk for aortic aneurysm or
dissection within 60 days compared with macrolide use. The
risk of FQ-associated aortic aneurysm or dissection compared
to macrolides can be replicated in German routine health
care data. Extending the analysis, we provided new insights
that the effect size may depend on the chosen AC.},
keywords = {Humans / Fluoroquinolones: adverse effects /
Fluoroquinolones: administration $\&$ dosage / Male / Female
/ Germany: epidemiology / Anti-Bacterial Agents: adverse
effects / Anti-Bacterial Agents: administration $\&$ dosage
/ Propensity Score / Aged / Aortic Dissection: epidemiology
/ Aortic Dissection: chemically induced / Middle Aged /
Cohort Studies / Aortic Aneurysm: epidemiology / Aortic
Aneurysm: chemically induced / Macrolides: adverse effects /
Adult / adverse drug reactions (Other) / aortic aneurysm
(Other) / fluoroquinolones (Other) / macrolides (Other) /
Fluoroquinolones (NLM Chemicals) / Anti-Bacterial Agents
(NLM Chemicals) / Macrolides (NLM Chemicals)},
cin = {AG Hänisch},
ddc = {610},
cid = {I:(DE-2719)1013010},
pnm = {354 - Disease Prevention and Healthy Aging (POF4-354)},
pid = {G:(DE-HGF)POF4-354},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:40285433},
doi = {10.1002/phar.70020},
url = {https://pub.dzne.de/record/279053},
}