Relative and Absolute Risk of Tendon Rupture with Fluoroquinolone and Concomitant Fluoroquinolone/Corticosteroid Therapy: Population-Based Nested Case-Control Study

Daniel R. Morales (Lead / Corresponding author), Jim Slattery, Alexandra Pacurariu, Luis Pinheiro, Patricia McGettigan, Xavier Kurz

Research output: Contribution to journalArticle

14 Citations (Scopus)
59 Downloads (Pure)

Abstract

Background and Objective: Tendon rupture can result from fluoroquinolone exposure. The objective of this study was to quantify relative and absolute risk and determine how risk is affected by timing of exposure.

Methods: The UK Health Improvement Network primary care database was used to perform a nested case-control study measuring the association between fluoroquinolone exposure and tendon rupture. Adults with tendon rupture were matched on age, sex, general practice and calendar time to four controls selected from a cohort prescribed systemic fluoroquinolone or co-amoxiclav antibiotics. The relative and absolute risk of tendon rupture with fluoroquinolone exposure was calculated.

Results: Current fluoroquinolone exposure was associated with an increased risk of any tendon rupture (adjusted incidence rate ratio [aIRR] 1.61, 95% CI 1.25-2.09) and Achilles tendon rupture (aIRR 3.14, 95% CI 2.11-4.65) that persisted for 60 days. Risk increased with cumulative exposure and was greatest when co-prescribed with oral corticosteroids (aIRR 19.36, 95% CI 7.78-48.19 for Achilles tendon rupture). The adjusted rate difference (aRD) with fluoroquinolone exposure was 2.9 and 2.1 per 10,000 patients for any and Achilles tendon rupture, respectively, and was greatest in people aged ≥ 60 years prescribed concomitant oral corticosteroid therapy (aDR 19.6 for any tendon and 6.6 Achilles tendon rupture per 10,000). No association was seen with co-amoxiclav or statin exposure, or with biceps or other tendon ruptures.

Conclusions: Risk of tendon rupture with fluoroquinolones depends on timing, cumulative dose and concomitant exposure to oral corticosteroids. Absolute risk significantly varied by age and concomitant corticosteroid exposure, affecting elderly patients the greatest.

Original languageEnglish
Pages (from-to)205-213
Number of pages9
JournalClinical Drug Investigation
Volume39
Issue number2
Early online date21 Nov 2018
DOIs
Publication statusPublished - Feb 2019

Keywords

  • Achilles Tendon/injuries
  • Adrenal Cortex Hormones/adverse effects
  • Adult
  • Aged
  • Anti-Bacterial Agents/adverse effects
  • Case-Control Studies
  • Female
  • Fluoroquinolones/adverse effects
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Risk
  • Rupture, Spontaneous
  • Tendon Injuries/chemically induced

Fingerprint Dive into the research topics of 'Relative and Absolute Risk of Tendon Rupture with Fluoroquinolone and Concomitant Fluoroquinolone/Corticosteroid Therapy: Population-Based Nested Case-Control Study'. Together they form a unique fingerprint.

  • Research Output

    • 14 Citations
    • 1 Article
    • 1 Letter

    Correction to: Relative and Absolute Risk of Tendon Rupture with Fluoroquinolone and Concomitant Fluoroquinolone/Corticosteroid Therapy: Population-Based Nested Case-Control Study

    Morales, D. R., Slattery, J., Pacurariu, A., Pinheiro, L., McGettigan, P. & Kurz, X., Feb 2019, In : Clinical Drug Investigation. 39, 2, p. 215 1 p.

    Research output: Contribution to journalArticle

    Open Access
    File
  • 1 Citation (Scopus)
    123 Downloads (Pure)

    Cite this