Evidence Linking Some Fluoroquinolones to Uveitis Grows

Susan London

October 07, 2014

Moxifloxacin appears to increase the risk for uveitis according to a case-control study published online October 2 in JAMA Ophthalmology. Ciprofloxacin was also associated with increased risk, but there was little to no increase seen for levofloxacin.

"The results of the present study are consistent with those of case reports that have suggested an association between oral moxifloxacin and uveitis," the investigators maintain. In addition, the study confirms that this adverse effect most commonly occurs with a first dispensed prescription.

Results also suggest that moxifloxacin was the riskiest of the three fluoroquinolones studied, possibly because it may have a higher tissue-binding affinity, the authors propose.

"Clinicians should be aware of a possible risk for uveitis with oral moxifloxacin or ciprofloxacin when deciding to prescribe these medications," the investigators recommend.

The team, led by Brennan Eadie, MD, PhD, from the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada, used a health claims database to identify men aged 40 to 85 years who had follow-up from January 2001 through December 2011. The authors matched 13,313 men with a new diagnosis of uveitis with 133,130 men without that diagnosis who had a similar age, cohort entry date, and follow-up duration.

Current first-time users of moxifloxacin who had received a prescription in the past 15 days had a 2.98-fold higher adjusted rate of uveitis compared with men not taking the drug. Current first-time users of ciprofloxacin had a 1.96-fold higher adjusted rate.

The risk for uveitis was likewise elevated, but to a smaller extent, for current repeat users of moxifloxacin and ciprofloxacin, who were on at least their second prescription (with respective 1.81-fold and 1.73-fold higher adjusted rates), as well as for past users who had received a prescription more than 15 days ago (with respective 1.31-fold and 1.14-fold higher adjusted rates).

In contrast, although the researchers saw a trend for increased risk among first-time users of levofloxacin compared with nonusers, the difference was not statistically significant. However, past users of levofloxacin had a 1.12-fold higher adjusted rate of this outcome.

The authors noted several study limitations, including restricting the study population to older men, which may limit the generalizability of the findings. Furthermore, as uveitis often has an unknown etiology, analyses may not have captured all potential confounders.

"Future studies, if able, would benefit from analyzing relationships between individual moxifloxacin dosing regimens and uveitis," the authors note.

The authors have disclosed no relevant financial relationships.

JAMA Ophthalmology. Published online October 2, 2014. Abstract

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