Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Translational Center for Excellence for Neuroepidemiology and Neurological Outcomes Research, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Muscle Nerve. 2021 Aug;64(2):156-162. doi: 10.1002/mus.27230. Epub 2021 Mar 26.
INTRODUCTION/AIMS: Anecdotal case reports have suggested a potential association of fluoroquinolones and macrolides with myasthenia gravis (MG) exacerbation, prompting warnings against the use of these drugs in this population. However, large-scale and reliable population-based data that demonstrate this association are lacking. This study aims to examine the association between outpatient treatment with fluoroquinolones or macrolides and MG-related hospitalization.
A retrospective cohort study consisting of adult MG patients was conducted using a large de-identified healthcare claims database. Antibiotic prescription claims were identified, and MG-related hospitalizations were assessed at 15, 30, and 90 days after the date of prescription. We used mixed effects survival regression with log-logistic distribution and independent covariance matrix to estimate odds ratios (ORs) of hospitalization for each potentially exacerbating antibiotic using beta-lactam as the reference and adjusting for covariates.
Among 1556 MG patients receiving 894 fluoroquinolone prescriptions, 729 macrolide prescriptions, and 1608 beta-lactam prescriptions during the study period, there was no difference in 15, 30, or 90-day odds of MG-related hospitalization between fluoroquinolone or macrolide users compared to prescribed beta-lactams. However, estimates were higher for fluoroquinolones than macrolides, even after covariate adjustment (adjusted OR [aOR] 4.60, 95% confidence interval [CI] 0.55-38.57 for fluoroquinolones and OR 0.56, 95% CI 0.32-0.97 for macrolides, respectively, at 15 days).
Fluoroquinolone and macrolide antibiotics are prescribed frequently to patients with MG. While statistical imprecision precludes a definitive conclusion, elevated ORs for fluoroquinolones raise the possibility of an underpowered association that merits further investigation.
介绍/目的：一些病例报告表明，氟喹诺酮类和大环内酯类药物与重症肌无力（MG）恶化之间存在潜在关联，这促使人们警告在该人群中使用这些药物。然而，缺乏大规模且可靠的基于人群的证据来证明这种关联。本研究旨在研究门诊使用氟喹诺酮类或大环内酯类药物与 MG 相关住院治疗之间的关联。
本研究采用回顾性队列研究，使用大型去标识医疗保健索赔数据库纳入成年 MG 患者。确定抗生素处方，并在处方日期后 15、30 和 90 天评估与 MG 相关的住院治疗情况。我们使用混合效应生存回归模型，采用对数-对数分布和独立协方差矩阵，使用β-内酰胺作为参考，调整协变量后，估计每种潜在加重抗生素（氟喹诺酮类或大环内酯类）的住院治疗比值比（OR）。
在研究期间，接受氟喹诺酮类 894 次处方、大环内酯类 729 次处方和β-内酰胺类 1608 次处方的 1556 名 MG 患者中，与使用β-内酰胺类药物相比，氟喹诺酮类或大环内酯类药物使用者在 15、30 或 90 天内发生 MG 相关住院治疗的几率没有差异。然而，即使在调整协变量后，氟喹诺酮类的估计值仍高于大环内酯类（氟喹诺酮类的调整 OR [aOR]为 4.60，95%置信区间 [CI]为 0.55-38.57，而大环内酯类的 OR 为 0.56，95%CI 为 0.32-0.97，分别在 15 天）。
氟喹诺酮类和大环内酯类抗生素经常被开给 MG 患者。尽管统计上的不精确性使得无法得出明确的结论，但氟喹诺酮类的 OR 升高提示存在潜在关联的可能性，这需要进一步研究。
