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September 30, 2014; 83 (14) Article

Oral fluoroquinolone use and risk of peripheral neuropathy

A pharmacoepidemiologic study

Mahyar Etminan, James M. Brophy, Ali Samii
First published August 22, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000846
Mahyar Etminan
From the Department of Pediatrics (M.E.), Faculty of Medicine, University of British Columbia, Vancouver; Therapeutic Evaluation Unit (M.E.), Child & Family Research Institute of British Columbia, Vancouver; Department of Medicine, Epidemiology and Biostatistics (J.M.B.), McGill University, Montreal, Canada; and Department of Neurology (A.S.), University of Washington, Seattle.
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James M. Brophy
From the Department of Pediatrics (M.E.), Faculty of Medicine, University of British Columbia, Vancouver; Therapeutic Evaluation Unit (M.E.), Child & Family Research Institute of British Columbia, Vancouver; Department of Medicine, Epidemiology and Biostatistics (J.M.B.), McGill University, Montreal, Canada; and Department of Neurology (A.S.), University of Washington, Seattle.
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Ali Samii
From the Department of Pediatrics (M.E.), Faculty of Medicine, University of British Columbia, Vancouver; Therapeutic Evaluation Unit (M.E.), Child & Family Research Institute of British Columbia, Vancouver; Department of Medicine, Epidemiology and Biostatistics (J.M.B.), McGill University, Montreal, Canada; and Department of Neurology (A.S.), University of Washington, Seattle.
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Citation
Oral fluoroquinolone use and risk of peripheral neuropathy
A pharmacoepidemiologic study
Mahyar Etminan, James M. Brophy, Ali Samii
Neurology Sep 2014, 83 (14) 1261-1263; DOI: 10.1212/WNL.0000000000000846

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Abstract

Objective: To quantify the risk of peripheral neuropathy (PN) with oral fluoroquinolone (FQ) use.

Methods: We conducted a case-control study within a cohort of men aged 45 to 80 years in the United States followed from 2001 to 2011. Cases were defined as those with the first physician visit diagnosis of PN, polyneuropathy, or drug-induced polyneuropathy. Four controls were matched to each case by age, follow-up, and calendar time using density-based sampling. As a sensitivity analysis, we also quantified the risk of PN with finasteride use, a drug that is not expected to increase the risk of PN. Rate ratios (RRs) for current users of FQs were computed using conditional logistic regression, which was adjusted for chronic renal failure, chronic liver disease, hypothyroidism, postherpetic neuralgia, and the use of nitrofurantoin and metronidazole.

Results: We identified 6,226 cases and 24,904 controls. Current users of FQs were at a higher risk of developing PN (RR = 1.83, 95% confidence interval [CI] 1.49–2.27). Current new users had the highest risk (RR = 2.07, 95% CI 1.56–2.74). No risk was observed for current users of finasteride (RR = 1.21, 95% CI 0.97–1.51).

Conclusions: Current users, especially new users of FQs, are at a higher risk of developing PN. Despite the increase in the use of FQs, clinicians should weigh the benefits against the risk of adverse events when prescribing these drugs to their patients.

GLOSSARY

CI=
confidence interval;
FDA=
Food and Drug Administration;
FQ=
fluoroquinolone;
ICD-9=
International Classification of Diseases, ninth revision;
PN=
peripheral neuropathy;
RR=
rate ratio

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received April 22, 2014.
  • Accepted in final form July 2, 2014.
  • © 2014 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence

  • 'Update': Oral fluoroquinolone use and risk of peripheral neuropathy: A pharmacoepidemiologic study
    • Mahyar Etminan, Scientist, The University of British Columbiametminan@popi.ubc.ca
    • James M. Brophy, Montreal, QC; Ali Samii, Seattle, WA
    Submitted October 14, 2014
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