Sandhu Harpal Singh, Brucker Alexander J, Ma Liyuan, VanderBeek Brian L
Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Leonard Davis Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
JAMA Ophthalmol. 2016 Jan;134(1):38-43. doi: 10.1001/jamaophthalmol.2015.4092.
Fluoroquinolones are the most commonly prescribed antibiotic class in the outpatient setting. Recent reports have implicated an association between oral fluoroquinolones and an increased risk of uveitis.
To determine the hazard of uveitis with oral fluoroquinolone use.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted using medical claims data from a large national US insurer (N = 4,387,651). Cohorts from ambulatory care centers across the United States were created including every new user of an oral fluoroquinolone or β-lactam antibiotic prescription with at least 24 months of data prior to the date of the prescription from January 1, 2000, to January 30, 2013. Exclusion criteria consisted of any previous diagnosis of uveitis or a uveitis-associated systemic illness. Participants were censored for a new diagnosis of a uveitis-associated systemic illness, the end of an observation period, use of the other class of antibiotic, or removal from the insurance plan. Data analysis was performed from January 2 through March 15, 2015.
The hazard of a uveitis diagnosis after a fluoroquinolone prescription compared with a β-lactam prescription using multivariate regression with Cox proportional hazards models.
Of the 4,387,651 patients in the database, 843,854 individuals receiving a fluoroquinolone and 3,543,797 patients receiving a β-lactam were included in the analysis. After controlling for age, race, and sex using multivariate analysis, no hazard for developing uveitis at the 30-, 60-, or 90-day observation windows was seen (hazard ratio [HR] range, 0.96; 95% CI, 0.82-1.13; to 1.05; 95% CI, 0.95-1.16; P > .38 for all comparisons). The 365-day observation period showed a small increase in the HR for the fluoroquinolone cohort (1.11; 95% CI, 1.05-1.17; P < .001). Moxifloxacin produced an increased hazard for uveitis at every time point (HR range, 1.47-1.75; 95% CI, 1.27-2.37; P < .001 for all comparisons). Secondary analysis demonstrated a similar hazard at 365 days for a later diagnosis of a uveitis-associated systemic illness after fluoroquinolone use (HR range, 1.46-1.96; 95% CI, 1.42-2.07; P < .001 for all comparisons).
These data do not support an association between oral fluoroquinolone use and uveitis. Instead, this study shows an association between oral fluoroquinolone use and the risk for uveitis-associated systemic illnesses, which is a possible source of bias that could explain the findings of previous studies.
氟喹诺酮类药物是门诊环境中最常开具的抗生素类别。最近的报告表明口服氟喹诺酮类药物与葡萄膜炎风险增加之间存在关联。
确定使用口服氟喹诺酮类药物引发葡萄膜炎的风险。
设计、设置和参与者：使用来自美国一家大型全国性保险公司的医疗理赔数据（N = 4,387,651）进行了一项回顾性队列研究。创建了来自美国各地门诊护理中心的队列，纳入了2000年1月1日至2013年1月30日期间开具口服氟喹诺酮类药物或β-内酰胺类抗生素处方的每位新用户，且在处方日期前至少有24个月的数据。排除标准包括既往任何葡萄膜炎或与葡萄膜炎相关的全身性疾病诊断。参与者因新诊断出与葡萄膜炎相关的全身性疾病、观察期结束、使用另一类抗生素或退出保险计划而被截尾。数据分析于2015年1月2日至3月15日进行。
使用Cox比例风险模型进行多变量回归，比较氟喹诺酮类药物处方后与β-内酰胺类药物处方后葡萄膜炎诊断的风险。
数据库中的4,387,651名患者中，843,854名接受氟喹诺酮类药物治疗的个体和3,543,797名接受β-内酰胺类药物治疗的患者纳入分析。在使用多变量分析控制年龄、种族和性别后，在30天、60天或90天观察期内未发现发生葡萄膜炎的风险（风险比[HR]范围为0.96；95%置信区间为0.82 - 1.13；至1.05；95%置信区间为0.95 - 1.16；所有比较的P > 0.38）。365天观察期显示氟喹诺酮类药物队列的HR略有增加（1.11；95%置信区间为1.05 - 1.17；P < 0.001）。莫西沙星在每个时间点都使葡萄膜炎风险增加（HR范围为任1.47 - 1.75；95%置信区间为1.27 - 2.37；所有比较的P < 0.001）。二次分析显示，氟喹诺酮类药物使用后365天，后期诊断出与葡萄膜炎相关的全身性疾病的风险相似（HR范围为1.46 - 1.96；95%置信区间为1.42 - 2.07；所有比较的P < 0.001）。
这些数据不支持口服氟喹诺酮类药物使用与葡萄膜炎之间存在关联。相反，本研究表明口服氟喹诺酮类药物使用与葡萄膜炎相关全身性疾病的风险之间存在关联，这可能是一个偏差来源，能够解释既往研究的结果。
