Yet another study has suggested that fluoroquinolone antibiotics – a class of drugs that includes Levaquin, Cipro, and Avelox — may elevate a patient’s risk for aortic aneurysm and aortic dissection.
The study, which recently appeared in the Journal of the American College of Cardiology, drew data from a Taiwanese national administrative database, with the authors analyzing records from 1,213 patients who were hospitalized for aortic injuries between 2001 and 2011 and 1,213 matched controls.
The authors of the study then compared fluoroquinolone exposure during a 60-day period before aortic aneurysm or aortic dissection diagnosis (hazard period) with exposure during a randomly selected 60-day period within 60 to 180 days before hospitalization (referent period).
According to their main analysis, exposure to fluoroquinolones was more frequent during the hazard period than during the referent period. The risk did not change when adjusted for infections and co-medication. Longer exposure to fluoroquinolones was associated with a greater risk for aortic aneurysm and aortic dissection.
A second analysis – the susceptible period analysis — suggested that exposure to fluoroquinolones within 60 days of aortic aneurysm or aortic dissection diagnosis was associated with high risk, while exposure within 120 or 180 days was not.
A case-time-control analysis suggested temporal changes in fluoroquinolone exposure were not related to aortic aneurysm or aortic dissection risk.
“Typically, [aortic aneurysms and aortic dissections] develop slowly in patients, but our data suggest that use of fluoroquinolone can contribute in the short term to aneurysm progression or rupture that may require emergency department visits and hospitalization,” the study authors wrote.
An accompanying editorial advised that it would be “prudent to entertain the possibly of aortic aneurysms/aortic dissection associated with fluoroquinolones use in patients presenting with chest pain, shortness of breath or syncope after recent exposure to the fluoroquinolones.”
Fluoroquinolone antibiotics – including Levaquin, Cipro, and Avelox — are indicated to treat a wide range of bacterial infections. However, in recent years the drugs have been the subject of multiple health warnings for peripheral neuropathy, tendon damage, and other persistent, debilitating side effects. In May 2016, the U.S. Food & Drug Administration (FDA) modified the boxed warning included on all fluoroquinolone labels to state that their risks outweigh any potential benefits for patients with certain uncomplicated infections when other treatment options are available.
This is not the first study to suggest a link between fluoroquinolone antibiotics and life-threatening aortic disorders.
In November 2015, for example, research published in JAMA: Internal Medicine indicated that people using the drugs were 2-times more likely to experience aortic aneurysm and aortic dissection within 60 days of exposure. The authors of that study also noted that fluoroquinolones have been tied to several collagen-related disorders. Collagen is a major extracellular matrix component of the aortic wall.
Johnson & Johnson and its Janssen Pharmaceuticals subsidiary have recently been named in several Levaquin lawsuits filed on behalf of individuals who allegedly suffered aortic aneurysm or dissection because of the medication.
Janssen discontinued production of oral and injectable versions of Levaquin in December 2017, ostensibly due to what the company said was “the wide availability of alternative treatment options.”
However, Levaquin has not been recalled, as the antibiotic will remain available at pharmacies until 2020.