Fluoroquinolones tied to risk for aortic and mitral regurgitation

  • Etminan M et al
  • JACC

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Use of oral fluoroquinolones is linked to an increased risk for mitral and aortic regurgitation.
  • Risk appears to be highest with current use; no associations observed among past users (>60 days postexposure).
  • Additional research is needed. See related editorial.

Why this matters

  • Consider non-fluoroquinolone antibiotics for patients with prior valvular regurgitation.

Key results

  • Cohort study of 8,272,981 patients including 12,502 valvulopathy cases and 125,020 controls (mean age, 58.1+12.7 years).
  • Disproportionality study: 102 reports of valvular regurgitation with fluoroquinolones, 6099 reports with other drugs (reporting OR, 1.45; 95% CI, 1.20-1.77).
  • Case control: adjusted rate ratio (aRR) for combined mitral/aortic regurgitation with current fluoroquinolone use:
    • 2.40 vs amoxicillin (95% CI, 1.82-3.16).
    • 1.75 vs azithromycin (95% CI, 1.34-2.29).
  • aRR for recent use (31-60 days) was significant vs amoxicillin (1.47; 95% CI, 1.03-2.09) but not azithromycin (1.37; 95% CI, 0.95-1.98).
  • The risk for past use (>60 days) of fluoroquinolones vs amoxicillin and
    azithromycin was very close to 1.00.

Study design

  • Drug adverse event disproportionality analysis comparing valvular regurgitation cases with fluoroquinolones vs other antibiotics during 2004-2018.
  • Case-control analysis to determine if fluoroquinolones increase aortic/mitral regurgitation risk.
  • Database: US FDA Adverse Event Reporting System (FAERS).
  • Funding:  British Columbia Provincial Health Services Authority.

Limitations

  • Reporting bias.
  • No data on unmeasured confounders.
  • Bias toward the null.
  • Limited generalizability.