Abstract
Previous studies have drawn causal associations between fluoroquinolone use and collagen pathologies including tendon rupture and retinopathy. This meta-analysisattempted to assess the association between fluoroquinolone use and the risk of aortic dissection or aortic aneurysm. A systematic search was performed on Medline, EMBASE, and the Cochrane library. 9 studies were included in final analysis. Primary random-effects meta-analysis of 7 studies, excluding 2 pharmacovigilance studies demonstrated statistically increased odds of aortic dissection (OR, 2.38; 95% CI, 1.71–3.32) aortic aneurysm (OR, 1.98; 95% CI, 1.59–2.48), and aortic aneurysm or dissection (OR, 1.47; 95% CI, 1.13–1.89; I2 = 72%) with current use of fluoroquinolones compared to their nonuser counterparts. Based on the “number needed-to-harm” analysis, 7246 (95% CI: 4329 to 14,085) patients would need to be treated with fluoroquinolones for a duration of at least three days in order for one additional patient to be harmed, assuming a population baseline incidence of aortic dissection and aneurysm rupture to be 10 per 100,000 patient-years. With strong statistical association, these findings suggest a causal relationship, warranting future research to elucidate the pathophysiological and mechanistic plausibility of this association. These findings however, should not cease prescription of fluoroquinolones, especially when clinically indicated.
Highlights
Previous studies have drawn causal associations between fluoroquinolone use and collagen pathologies including tendon rupture and retinopathy
There is moderate evidence from this meta-analysis demonstrating the heightened risk of aortic aneurysm or aortic dissection in patients treated with fluoroquinolones
Cellular studies of smooth muscle cells derived from aortic aneurysms demonstrate an increased expression of matrix metalloproteinases (MMPs)-9 and MMP-232, both of which potentiate collagenolytic activity[33, 34]
Summary
Previous studies have drawn causal associations between fluoroquinolone use and collagen pathologies including tendon rupture and retinopathy. This meta-analysis attempted to assess the association between fluoroquinolone use and the risk of aortic dissection or aortic aneurysm. In vitro studies have demonstrated the mechanistic associations attesting the properties of these antibiotic involved in potentiating the activity of matrix metalloproteinases, resulting in degradation of collagen and structural components of the extracellular matrix. This is accompanied by features of oxidative stress in tendon cells, and reduction of collagen production 7–10. The main objective of this present study was to appraise real-world evidence of the association between fluoroquinolone and the occurrence of aortic dissections or aneurysms
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