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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},
}