Methods: longitudinal cohort study of all older adults turning 65 years between Apr 1 1997 and Mar 31 2012 in Ontario, Canada. FQ use was measured as a time-varying covariate, with patients considered to be at risk during and 30 days following treatment. Tendon ruptures, retinal detachments, and aortic aneurysm events diagnosed in province wide hospital and emergency room datasets in Ontario’s universal healthcare system. Patients were followed until they experienced an outcome event, died, or reached the end of follow-up period (Mar 31 2014).
Results: Among 1,744,360 eligible older adults, 657,950 (38%) received at least one FQ during follow up, amounting to 22,380,515 days of FQ treatment. The patients experienced 37,338 (2.1%) tendon ruptures, 3,246 (0.2%) retinal detachments, and 18,391 (1.1%) aortic aneurysms. Severe collagen-associated adverse events were more common during FQ treatment than control periods, including tendon ruptures (0.82 vs 0.26 per 100-person years (py), p<0.001), retinal detachments (0.03 vs 0.02 per 100-py, p=0.003) and aortic aneurysms (0.35 vs 0.13 per 100-py, p<0.001). Current FQs were associated with increases in tendon rupture (HR 3.13, 95%CI 2.98-3.28; adjusted HR 2.40, 95%CI 2.24-2.57), and a similar increase in aortic aneurysms (HR 2.72, 95%CI 2.53-2.93; adjusted HR2.24, 95%CI 2.02-2.49), which was substantially greater in magnitude than the association of these outcomes with amoxicillin. The hazard of retinal detachment was marginal (HR 1.28, 95%CI 0.99-1.65; adjusted HR 1.47, 95%CI 1.08-2.00), and not greater in magnitude than that observed with amoxicillin.
Conclusion: FQ treatment is indeed associated with subsequent tendon ruptures, and may also contribute to aortic aneurysms.
D. Redelmeier, None