Long-Term Risk of Cardiovascular Death with Use of Clarithromycin and Roxithromycin : A Nationwide Cohort Study
(2018) In American Journal of Epidemiology 187(4). p.777-785- Abstract
Recent studies have raised concern that macrolide antibiotics may be associated with an increased long-term risk of cardiovascular death. We examined the 1-year risk associated with treatment with clarithromycin (n = 187,887) or roxithromycin (n = 698,899) compared with penicillin V (n = 3,473,081) matched 1:4 on propensity score, in a nationwide, registry-based cohort study in Danish outpatients, 1997-2011. Among clarithromycin courses, the rate ratio for cardiovascular death was 1.24 (95% confidence interval (CI): 0.96, 1.59). Among roxithromycin courses, the rate ratio was 0.99 (95% CI: 0.86, 1.16). In analyses by time after treatment start, the rate ratio associated with clarithromycin was 1.66 (95% CI: 0.98, 2.79) during days 0-7.... (More)
Recent studies have raised concern that macrolide antibiotics may be associated with an increased long-term risk of cardiovascular death. We examined the 1-year risk associated with treatment with clarithromycin (n = 187,887) or roxithromycin (n = 698,899) compared with penicillin V (n = 3,473,081) matched 1:4 on propensity score, in a nationwide, registry-based cohort study in Danish outpatients, 1997-2011. Among clarithromycin courses, the rate ratio for cardiovascular death was 1.24 (95% confidence interval (CI): 0.96, 1.59). Among roxithromycin courses, the rate ratio was 0.99 (95% CI: 0.86, 1.16). In analyses by time after treatment start, the rate ratio associated with clarithromycin was 1.66 (95% CI: 0.98, 2.79) during days 0-7. This was attenuated in later time periods (days 8-89, rate ratio = 1.30, 95% CI: 0.88, 1.94; and days 90-364, rate ratio = 0.96, 95% CI: 0.63, 1.47). For roxithromycin, the rate ratios were 0.88 (95% CI: 0.59, 1.32) during days 0-7, 1.17 (95% CI: 0.92, 1.48) during days 8-89, and 0.88 (95% CI: 0.70, 1.10) during days 90-364. We found no increased risk of cardiovascular death in a general outpatient population. With clarithromycin, we observed a transient increased risk during days 0-7 after treatment start, which corresponds to the period of active treatment. This association was absent in later time periods, which is consistent with no long-term toxicity resulting in cardiovascular death.
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- author
- Inghammar, Malin LU ; Nibell, Olof LU ; Pasternak, Björn LU ; Melbye, Mads ; Svanström, Henrik and Hviid, Anders
- organization
- publishing date
- 2018-04-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- cardiovascular death, clarithromycin, epidemiology, macrolides, roxithromycin
- in
- American Journal of Epidemiology
- volume
- 187
- issue
- 4
- pages
- 9 pages
- publisher
- Oxford University Press
- external identifiers
-
- pmid:29155931
- scopus:85044758663
- ISSN
- 0002-9262
- DOI
- 10.1093/aje/kwx359
- project
- Drug-induced liver injuries caused by antimicrobials: Incidence and etiology based on Swedish population data
- language
- English
- LU publication?
- yes
- id
- c27238c3-0e72-4834-824b-4c68facd4d66
- date added to LUP
- 2018-05-23 10:57:00
- date last changed
- 2024-04-01 06:02:12
@article{c27238c3-0e72-4834-824b-4c68facd4d66,
abstract = {{<p>Recent studies have raised concern that macrolide antibiotics may be associated with an increased long-term risk of cardiovascular death. We examined the 1-year risk associated with treatment with clarithromycin (n = 187,887) or roxithromycin (n = 698,899) compared with penicillin V (n = 3,473,081) matched 1:4 on propensity score, in a nationwide, registry-based cohort study in Danish outpatients, 1997-2011. Among clarithromycin courses, the rate ratio for cardiovascular death was 1.24 (95% confidence interval (CI): 0.96, 1.59). Among roxithromycin courses, the rate ratio was 0.99 (95% CI: 0.86, 1.16). In analyses by time after treatment start, the rate ratio associated with clarithromycin was 1.66 (95% CI: 0.98, 2.79) during days 0-7. This was attenuated in later time periods (days 8-89, rate ratio = 1.30, 95% CI: 0.88, 1.94; and days 90-364, rate ratio = 0.96, 95% CI: 0.63, 1.47). For roxithromycin, the rate ratios were 0.88 (95% CI: 0.59, 1.32) during days 0-7, 1.17 (95% CI: 0.92, 1.48) during days 8-89, and 0.88 (95% CI: 0.70, 1.10) during days 90-364. We found no increased risk of cardiovascular death in a general outpatient population. With clarithromycin, we observed a transient increased risk during days 0-7 after treatment start, which corresponds to the period of active treatment. This association was absent in later time periods, which is consistent with no long-term toxicity resulting in cardiovascular death.</p>}},
author = {{Inghammar, Malin and Nibell, Olof and Pasternak, Björn and Melbye, Mads and Svanström, Henrik and Hviid, Anders}},
issn = {{0002-9262}},
keywords = {{cardiovascular death; clarithromycin; epidemiology; macrolides; roxithromycin}},
language = {{eng}},
month = {{04}},
number = {{4}},
pages = {{777--785}},
publisher = {{Oxford University Press}},
series = {{American Journal of Epidemiology}},
title = {{Long-Term Risk of Cardiovascular Death with Use of Clarithromycin and Roxithromycin : A Nationwide Cohort Study}},
url = {{http://dx.doi.org/10.1093/aje/kwx359}},
doi = {{10.1093/aje/kwx359}},
volume = {{187}},
year = {{2018}},
}