Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida.
Saudi Food and Drug Authority, Riyadh, Saudi Arabia.
Pharmacotherapy. 2019 Dec;39(12):1167-1178. doi: 10.1002/phar.2343. Epub 2019 Nov 25.
To examine whether concomitant use of quinolones and stimulants increases the risk of cardiac events in adults.
A retrospective cohort study of privately insured adults using MarketScan claims data from 2008 to 2015.
Stimulant (methylphenidate or mixed amphetamine salts) users (18-65 yrs old) with continuous health plan enrollment for the 6 months (baseline) prior to the first dispensation (index date) of oral quinolones or comparators (amoxicillin ± clavulanate or azithromycin). OUTCOMES DEFINITION: (1) Cardiac symptoms (palpitation, tachycardia, or syncope); (2) cardiac arrhythmias (ventricular arrhythmias, paroxysmal ventricular tachycardia, or cardiac arrest).
Baseline covariates adjustment was through inverse probability of treatment weighting. Adults were followed until the antimicrobial therapy ended. The hazard of cardiac events in stimulant-quinolones-exposed adults was compared to those who were treated with stimulant-comparator antibiotics using a weighted Cox regression model. Several sensitivity analyses were performed to challenge the results robustness.
The study cohorts comprised 390,490 stimulants users who initiated either quinolone or amoxicillin, and 387,574 patients receiving stimulants who initiated quinolone or azithromycin. The unadjusted incidence rate for cardiac symptoms in stimulant-quinolones users was 471 cases/10,000 patient-years, and it was 244 cases/10,000 patient-years in patients exposed to stimulant-amoxicillin; whereas the unadjusted incidence rate for cardiac symptoms was 728 and 358 per 10,000 patient-years for stimulant-quinolones and stimulant-azithromycin cohorts, respectively. Compared to stimulant-amoxicillin use, the adjusted hazard ratio (HR) for cardiac symptoms with stimulant-quinolones use was 1.61 (95% confidence interval [CI], 1.30-1.98). The HR for cardiac symptoms for patient exposed to stimulant-quinolones was 1.69 (95% CI, 1.32-2.13) when compared to stimulant-azithromycin. The sensitivity analysis findings were consistent with the primary analysis. A few patients across the study comparison groups developed cardiac arrhythmias.
Concomitant use of stimulants and quinolone was associated with an increased hazard of cardiac symptoms in comparison to concomitant use of stimulants and amoxicillin or azithromycin, but there was no apparent difference in cardiac arrhythmias.
研究喹诺酮类药物与兴奋剂合用是否会增加成年人心脏事件的风险。
这是一项回顾性队列研究，使用 2008 年至 2015 年市场扫描索赔数据，对私人保险的成年人进行研究。
（18-65 岁）兴奋剂（哌醋甲酯或混合安非他命盐）使用者，在口服喹诺酮类药物或对照剂（阿莫西林±克拉维酸或阿奇霉素）首次配药（索引日期）前 6 个月（基线）内持续参加健康计划。
（1）心脏症状（心悸、心动过速或晕厥）；（2）心律失常（室性心律失常、阵发性室性心动过速或心脏骤停）。
通过逆概率治疗加权法调整基线协变量。在抗生素治疗结束前，对成年人进行随访。使用加权 Cox 回归模型比较接受兴奋剂-喹诺酮类药物暴露的成年人与接受兴奋剂-对照抗生素治疗的成年人的心脏事件风险。进行了几项敏感性分析以检验结果的稳健性。
研究队列包括 390490 名开始使用喹诺酮类药物或阿莫西林的兴奋剂使用者，以及 387574 名开始使用喹诺酮类药物或阿奇霉素的接受兴奋剂治疗的患者。兴奋剂-喹诺酮类药物使用者的心脏症状未调整发生率为 471 例/10000 患者-年，而接受兴奋剂-阿莫西林治疗的患者为 244 例/10000 患者-年；而兴奋剂-喹诺酮类药物和兴奋剂-阿奇霉素队列的未调整心脏症状发生率分别为 728 和 358 例/10000 患者-年。与使用兴奋剂-阿莫西林相比，使用兴奋剂-喹诺酮类药物的心脏症状调整后的危险比（HR）为 1.61（95%置信区间[CI]，1.30-1.98）。与使用兴奋剂-阿奇霉素相比，接受兴奋剂-喹诺酮类药物治疗的患者的心脏症状 HR 为 1.69（95% CI，1.32-2.13）。在整个研究比较组中，少数患者出现心律失常。
与同时使用兴奋剂和阿莫西林或阿奇霉素相比，同时使用兴奋剂和喹诺酮类药物与心脏症状的发生风险增加相关，但心脏心律失常无明显差异。
