Systemic Fluoroquinolone Use and Risk of Uveitis or Retinal Detachment

• Published in: JAMA ophthalmology Vol. 142; no. 7; p. 636
• Main Authors: Brown, Jeremy P, Wing, Kevin, Evans, Stephen J, Leyrat, Clémence, Mansfield, Kathryn E, Smeeth, Liam, Wong, Angel Y S, Yorston, David, Galwey, Nicholas W, Douglas, Ian J
• Format: Journal Article
• Language: English
• Published: United States 01-07-2024
• Subjects: Adult; Aged; Anti-Bacterial Agents - adverse effects; Databases, Factual; Female; Fluoroquinolones - adverse effects; Humans; Incidence; Male; Middle Aged; Retinal Detachment - chemically induced; Retinal Detachment - diagnosis; Retinal Detachment - epidemiology; Retrospective Studies; Risk Factors; United Kingdom - epidemiology; Uveitis - chemically induced; Uveitis - diagnosis; Uveitis - drug therapy; United Kingdom
• ISSN: 2168-6173
• DOI: 10.1001/jamaophthalmol.2024.1712

Fluoroquinolone use has been associated with increased risk of uveitis and retinal detachment in noninterventional studies, but the findings have been conflicting and causality is unclear.
To estimate the association of systemic fluoroquinolone use with acute uveitis or retinal detachment, using multiple analyses and multiple databases to increase the robustness of results.
This cohort study used data from the Clinical Practice Research Datalink Aurum and GOLD UK primary care records databases, which were linked to hospital admissions data. Adults prescribed a fluoroquinolone or a comparator antibiotic, cephalosporin, between April 1997 and December 2019 were included. Adults with uveitis or retinal detachment were analyzed in a separate self-controlled case series. Data analysis was performed from May 2022 to May 2023.
Systemic fluoroquinolone or comparator antibiotic.
The primary outcome was a diagnosis of acute uveitis or retinal detachment. Hazard ratios (HRs) were estimated in the cohort study for the association of fluoroquinolone prescription with either uveitis or retinal detachment, using stabilized inverse probability of treatment weighted Cox regression. Rate ratios (RRs) were estimated in the self-controlled case series, using conditional Poisson regression. Estimates were pooled across databases using fixed-effects meta-analysis.
In total, 3 001 256 individuals in Aurum (1 893 561 women [63.1%]; median [IQR] age, 51 [35-68] years) and 434 754 in GOLD (276 259 women [63.5%]; median [IQR] age, 53 [37-70] years) were included in the cohort study. For uveitis, the pooled adjusted HRs (aHRs) for use of fluoroquinolone vs cephalosporin were 0.91 (95% CI, 0.72-1.14) at first treatment episode and 1.07 (95% CI, 0.92-1.25) over all treatment episodes. For retinal detachment, the pooled aHRs were 1.37 (95% CI, 0.80-2.36) at first treatment episode and 1.18 (95% CI, 0.84-1.65) over all treatment episodes. In the self-controlled case series, for uveitis, the pooled adjusted RRs (aRRs) for fluoroquinolone use vs nonuse were 1.13 (95% CI, 0.97-1.31) for 1 to 29 days of exposure, 1.16 (95% CI, 1.00-1.34) for 30 to 59 days, and 0.98 (95% CI, 0.74-1.31) for 60 days for longer. For retinal detachment, pooled aRRs for fluoroquinolone use vs nonuse were 1.15 (95% CI, 0.86-1.54) for 1 to 29 days of exposure, 0.94 (95% CI, 0.69-1.30) for 30 to 59 days, and 1.03 (95% CI, 0.59-1.78) for 60 days or longer.
These findings do not support an association of systemic fluoroquinolone use with substantively increased risk of uveitis or retinal detachment. Although an association cannot be completely ruled out, these findings indicate that any absolute increase in risk would be small and, hence, of limited clinical importance.