环素类抗生素与假性脑瘤综合征发展之间的关联。

Association between cycline antibiotic and development of pseudotumor cerebri syndrome.

机构信息

Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota.

Department of Ophthalmology and Visual Sciences, University of Michigan School of Medicine, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan.

出版信息

J Am Acad Dermatol. 2019 Aug;81(2):456-462. doi: 10.1016/j.jaad.2019.03.041. Epub 2019 Mar 21.

DOI:10.1016/j.jaad.2019.03.041

PMID:30905802

Abstract

BACKGROUND

Cycline antibiotics (CAs) are commonly used to treat acne, blepharitis, and dry eye syndrome. Prescribers or patients may hesitate to use Cas because they may increase the risk of pseudotumor cerebri syndrome (PTCS).

OBJECTIVE

We sought to assess whether CA use is associated with an increased risk of PTCS or papilledema and whether the risk depends upon dosage or duration of CA intake.

METHODS

We studied patients 12 to 65 years of age who were diagnosed with acne, blepharitis, or dry eye syndrome, who were enrolled in a nationwide managed care network between January 1, 2001 and December 31, 2015, and who had no preexisting diagnosis of papilledema or PTCS. Multivariable Cox regression modeling was used to assess the risk of developing papilledema or PTCS from exposure to CAs.

RESULTS

Among the 728,811 eligible enrollees (mean age, 34.7 years; 72% female), 42.0% filled ≥1 CA prescription. Of the 305,823 CA users, 170 (0.06%) were diagnosed with papilledema or PTCS. By comparison, of the 57.0% with no record of CA use, 121 (0.03%) were diagnosed with papilledema or PTCS (P < .0001). In the unadjusted model, every additional year of CA use was associated with a 70% (doxycycline: hazard ratio, 1.70 [95% confidence interval 0.98-2.97]; P = .06) or 91% (minocycline: hazard ratio, 1.91 [95% confidence interval 1.11-3.29]; P = .02) increased hazard of papilledema/PTCS relative to nonusers of CAs. After adjustment for confounders, the increased hazard of PTCS/papilledema with CA use was no longer statistically significant (P = .06, doxycycline; P = .08, minocycline).

LIMITATIONS

This study relies on claims data, which lack clinical data.

CONCLUSION

This study offers some evidence that CAs may increase the risk of PTCS/papilledema. However, after accounting for confounding factors in our multivariable models, we found no statistically significant association between CA use and the development of PTCS. Moreover, there was no dose-response effect whereby greater CA use was associated with a higher PTCS risk.

摘要

背景

环素类抗生素（CAs）常用于治疗痤疮、睑缘炎和干眼症。由于 CAs 可能会增加假性脑瘤综合征（PTCS）的风险，因此开处方者或患者可能会犹豫是否使用 CAs。

目的

我们旨在评估 CA 使用是否与 PTCS 或视盘水肿的风险增加相关，以及风险是否取决于 CA 摄入的剂量或持续时间。

方法

我们研究了年龄在 12 至 65 岁之间的患者，这些患者被诊断患有痤疮、睑缘炎或干眼症，于 2001 年 1 月 1 日至 2015 年 12 月 31 日期间在一个全国性的管理式医疗网络中注册，并且没有预先存在的视盘水肿或 PTCS 诊断。多变量 Cox 回归模型用于评估 CAs 暴露与视盘水肿或 PTCS 发展之间的风险。

结果

在 728811 名符合条件的参与者中（平均年龄 34.7 岁；72%为女性），42.0%的人填写了≥1 份 CA 处方。在 305823 名 CA 用户中，有 170 名（0.06%）被诊断为视盘水肿或 PTCS。相比之下，在没有 CA 使用记录的 57.0%的人中，有 121 名（0.03%）被诊断为视盘水肿或 PTCS（P<.0001）。在未调整的模型中，CA 使用的每增加一年与视盘水肿/PTCS 的风险增加 70%（多西环素：风险比，1.70 [95%置信区间 0.98-2.97]；P=.06）或 91%（米诺环素：风险比，1.91 [95%置信区间 1.11-3.29]；P=.02）相关。在调整混杂因素后，CA 使用与 PTCS/视盘水肿的风险增加不再具有统计学意义（P=.06，多西环素；P=.08，米诺环素）。