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Spotlight Session - Databases

Session: Spotlight Poster Session A

(ASPOT04) Use of Fluoroquinolones and Risk of Rhegmatogenous Retinal Detachment: A Retrospective Cohort Study Using Two National Representative Claims Data

Monday, August 26, 2024
8:00 AM – 6:00 PM CEST
Location: Foyer 3

    Co-Author(s)

  • HW

    Hsin-Min Wang

    Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, United States
    Gainesville, United States

  • Ting-Yu Lin, MS

    Graduated student
    Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan, Taiwan (Republic of China)

  • WL

    Wei-Hsuan Lo-Ciganic

    Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA, United States

  • YH

    Yu-Yun Huang

    Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, Taiwan (Republic of China)

  • MC

    Ming-Ching Chen

    Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan, Taiwan (Republic of China)

    • Presenting Author(s)

  • YD

    Yaa-Hui Dong, PhD (she/her/hers)

    Associate Professor
    Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
    Taipei, Taiwan (Republic of China)

    • Co-Author(s)

  • JW

    Jiun-Ling Wang

    Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, Taiwan (Republic of China)

Background: Biological plausibility suggests fluoroquinolones may cause rhegmatogenous retinal detachment (RRD) through collagen degradation. Yet, existing real-world studies on fluoroquinolones-related RRD show inconsistent findings and lack absolute risk estimates.

Objectives: To estimate the risk of RRD associated with fluoroquinolone use compared to other antibiotics with similar indications.

Methods: We conducted a retrospective cohort study using two national representative claims databases, the U.S. IBM MarketScan (2011-2020) and the Taiwan National Health Insurance Research Database (2009-2018). We included patients aged ≥18 years who initiated fluoroquinolones or comparison antibiotics (either amoxicillin/clavulanate, ampicillin/sulbactam or extended-spectrum cephalosporins). We followed up patients up to 90 days after fluoroquinolone or comparison antibiotic initiation until the first occurrence of RRD, disenrollment or death, or the study’s end. After 1:1 propensity score (PS) matching for each country data, we used Cox regression models to estimate the hazards ratio (HR) with 95% confidence interval (95%CI) of RRD for fluoroquinolones compared to other antibiotics. We used random-effects meta-analysis to derive pooled HRs across both counties.

Results: Among 24,172,032 eligible patients comprising 16,227,412 U.S. commercially insured individuals (mean age (SD)=46.67 (16.01), 40.48% male) and 7,944,620 insured Taiwanese (mean age (SD)=45.98 (17.94), 44.63% male), 10,137,468 initiated fluoroquinolones, 10,203,794 initiated amoxicillin/clavulanate or ampicillin/sulbactam, and 3,830,770 initiated extended-spectrum cephalosporins. The crude incidence rates of RRD per 1,000 person-years were 0.35 for fluoroquinolones, 0.31 for amoxicillin/clavulanate or ampicillin/sulbactam, and 0.32 for extended-spectrum cephalosporins. In each pairwise PS-matched cohort comparison, fluoroquinolone use was not associated with an increased RRD risk, with pooled HRs of 0.97 (95%CI, 0.76-1.23) versus amoxicillin/clavulanate or ampicillin/sulbactam and 1.08 (95%CI, 0.92-1.27) versus extended-spectrum cephalosporins, respectively. The findings remained consistent by country, various patient characteristic (e.g., age, sex, diabetes), type of fluoroquinolones, and follow-up duration.

Conclusions: Our comprehensive study, leveraging real-world data from the US and Taiwan, showed a low and comparable risk of RRD among adults initiating fluoroquinolones or comparator antibiotics with similar indications.