Associate Professor National Yang Ming Chiao Tung University, Taipei, Taiwan Taipei, Taiwan (Republic of China)
Background: Biological plausibility suggests that fluoroquinolones may damage collagen, which are important constitutes of the heart valves, and thereby potentially leads to mitral valve regurgitation or aortic valve regurgitation (MR/AR). However, available real-world studies were limited and yielded inconsistent findings.
Objectives: Using a population-based cohort study design, we examined the risk of MR/AR associated with fluoroquinolones versus other antibiotics with similar indications (i.e., comparison antibiotics).
Methods: We identified adult patients who initiated fluoroquinolones or comparison antibiotics from the Taiwan National Health Insurance Research Database between 2009 and 2017. Patients were followed for up to 60 days from cohort entry to the earliest of MR/AR occurrence, death, or end of data (Dec 31, 2018). Cox regression models were used to estimate the hazards ratio (HR) and 95% confidence interval (CI) of MR/AR comparing fluoroquinolones to comparison antibiotics after 1:1 propensity score (PS) matching. All analyses were stratified by type of fluoroquinolone (fluoroquinolones as a class, respiratory fluoroquinolones, non-respiratory fluoroquinolones) and comparison antibiotic (amoxicillin/clavulanate or ampicillin/sulbactam, extended-spectrum cephalosporins).
Results: A total of 6,649,284 eligible patients who initiated study antibiotics were identified. The crude incidence rates of MR/AR per 1,000 person-years were 2.11 for fluoroquinolones as a class, 4.99 for respiratory fluoroquinolones, 1.44 for non-respiratory fluoroquinolones, 2.07 for amoxicillin/clavulanate or ampicillin/sulbactam, and 1.51 for extended-spectrum cephalosporins. However, there was no elevated risk associated with fluoroquinolone use in each pairwise PS-matched cohort comparison. HRs were 1.00 (95% CI, 0.89-1.11) for fluoroquinolones as a class, 0.96 (95% CI, 0.83-1.12) for respiratory fluoroquinolones, and 0.87 (95% CI, 0.75-1.01) for non-respiratory fluoroquinolones, compared to amoxicillin/clavulanate or ampicillin/sulbactam. Results were similar when fluoroquinolones were compared to extended-spectrum cephalosporins (HRs of 0.96 [95% CI, 0.82-1.12], 1.05 [95% CI, 0.86-1.28], and 0.88 [95% CI, 0.75-1.03], respectively). The results did not change materially in several pre-specified subgroup and sensitivity analyses.
Conclusions: This large-scale cohort study did not find a higher risk of MR/AR associated with different types of fluoroquinolones in adult population.
