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Fluoroquinolones and the risk of tendon injury: a systematic review and meta-analysis

European Journal of Clinical Pharmacology volume 75, pages 1431–1443 (2019)Cite this article

Abstract

Purpose

Tendinopathy is a known adverse reaction associated to fluoroquinolones, but a meta-analysis was not yet published. The aim of this study was to conduct a systematic review and a meta-analysis of the scientific evidence evaluating the risk of tendon injury associated with fluoroquinolones.

Methods

A literature search was conducted to identify observational studies which reported results on the risk of Achilles tendon rupture (ATR), risk of Achilles tendinitis (AT), or risk of any tendon disorders (ATD). A meta-analysis was performed by pooling odds ratios (ORs) with their 95% confidence intervals (CIs).

Results

Fifteen studies were included in the meta-analysis. Treatment with fluoroquinolones was associated with an increased risk of ATR (OR 2.52 (95% CI 1.81–3.52), p < 0.001, I2 = 76.7%), an increased risk of AT (OR 3.95 (95% CI 3.11–5.01), p < 0.001, I2 = 0%), and increased risk of ATD (OR 1.98 (95% CI 1.62–2.43), p < 0.001, I2 = 84.5%). The initial risk estimates remained statistically significant among patients aged ≥ 60 years old. Risk estimates did not significantly change after depending on the concomitant use of corticosteroids or studies methodological quality assessment. The analysis according to the type of fluoroquinolones was only possible for ATR, which were ofloxacin and norfloxacin were found to increase the risk of this outcome, but not ciprofloxacin and levofloxacin.

Conclusions

The results of this meta-analysis confirm the risk of tendon injuries associated with fluoroquinolones. Older age and concomitant use of corticosteroids seem to be additional risk factors for tendinopathy.

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Authors and Affiliations

  1. Laboratory of Social Pharmacy and Public Health, School of Pharmacy, University of Coimbra, Coimbra, Portugal

    Carlos Alves & Francisco Batel Marques

  2. AIBILI – Association for Innovation and Biomedical Research on Light and Image, CHAD – Centre for Health Technology Assessment and Drug Research, Coimbra Regional Pharmacovigilance Unit (UFC), Coimbra, Portugal

    Carlos Alves, Diogo Mendes & Francisco Batel Marques

Authors
  1. Carlos Alves
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  2. Diogo Mendes
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  3. Francisco Batel Marques
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Contributions

Carlos Alves conceived and designed the study, performed research, analyzed data, and wrote the paper. Diogo Mendes and Francisco Batel Marques conceived the study and wrote the paper.

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Correspondence to Carlos Alves.

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Alves, C., Mendes, D. & Marques, F.B. Fluoroquinolones and the risk of tendon injury: a systematic review and meta-analysis. Eur J Clin Pharmacol 75, 1431–1443 (2019). https://doi.org/10.1007/s00228-019-02713-1

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  • DOI: https://doi.org/10.1007/s00228-019-02713-1

Keywords

  • Fluoroquinolones
  • Tendinopathy
  • Pharmacovigilance
  • Risk assessment
  • Meta-analysis