Oral fluoroquinolones and the risk of uveitis

Abstract

IMPORTANCE Fluoroquinolones are the most commonly prescribed antibiotic class in the outpatient setting. Recent reports have implicated an association between oral fluoroquinolones and an increased risk of uveitis. OBJECTIVE To determine the hazard of uveitis with oral fluoroquinolone use. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort studywas conducted using medical claims data from a large national US insurer (N = 4 387 651). Cohorts from ambulatory care centers across the United States were created including every new user of an oral fluoroquinolone or β-lactam antibiotic prescription with at least 24 months of data prior to the date of the prescription from January 1, 2000, to January 30, 2013. Exclusion criteria consisted of any previous diagnosis of uveitis or a uveitis-associated systemic illness. Participants were censored for a new diagnosis of a uveitis-associated systemic illness, the end of an observation period, use of the other class of antibiotic, or removal from the insurance plan. Data analysis was performed from January 2 through March 15, 2015. MAIN OUTCOMES AND MEASURES The hazard of a uveitis diagnosis after a fluoroquinolone prescription compared with a β-lactam prescription using multivariate regression with Cox proportional hazards models. RESULTS Of the 4 387 651 patients in the database, 843 854 individuals receiving a fluoroquinolone and 3 543 797 patients receiving a β-lactam were included in the analysis. After controlling for age, race, and sex using multivariate analysis, no hazard for developing uveitis at the 30-, 60-, or 90-day observation windows was seen (hazard ratio [HR] range, 0.96; 95%CI, 0.82-1.13; to 1.05; 95%CI, 0.95-1.16; P > .38 for all comparisons). The 365-day observation period showed a small increase in the HR for the fluoroquinolone cohort (1.11; 95%CI, 1.05-1.17; P < .001). Moxifloxacin produced an increased hazard for uveitis at every time point (HR range, 1.47-1.75; 95%CI, 1.27-2.37; P < .001 for all comparisons). Secondary analysis demonstrated a similar hazard at 365 days for a later diagnosis of a uveitis-associated systemic illness after fluoroquinolone use (HR range, 1.46-1.96; 95%CI, 1.42-2.07; P < .001 for all comparisons). CONCLUSIONS AND RELEVANCE These data do not support an association between oral fluoroquinolone use and uveitis. Instead, this study shows an association between oral fluoroquinolone use and the risk for uveitis-associated systemic illnesses, which is a possible source of bias that could explain the findings of previous studies.