Evidence map›Paper›PMID 30465300›Full record

ArticleClinical drug investigation2019

Relative and Absolute Risk of Tendon Rupture with Fluoroquinolone and Concomitant Fluoroquinolone/Corticosteroid Therapy: Population-Based Nested Case-Control Study.

Daniel R Morales, Jim Slattery, Alexandra Pacurariu, Luis Pinheiro, Patricia McGettigan, Xavier Kurz

Erratum issuedOpen access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical drug investigation, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 49 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
49citing papers in PubMed, 3 pooled it
6.5field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

49 citing papers in PubMed, 3 syntheses or guidelines pooled it, 98 citations in OpenAlex.

  1. Pooled it
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  17. Fluoroquinolone-Mediated Tendinopathy and Tendon Rupture.Pharmaceuticals (Basel, Switzerland) · 2025
    Review
  18. Article
  19. Fluoroquinolones: what do GPs need to know?The British journal of general practice : the journal of the Royal College of General Practitioners · 2025
    Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 1 country.

Daniel R MoralesDivision of Population Health and Genomics, School of Medicine, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK. d.r.z.morales@dundee.ac.uk.ORCID http://orcid.org/0000-0002-0063-8069
Jim SlatteryPharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK.
Alexandra PacurariuPharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK.
Luis PinheiroPharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK.
Patricia McGettiganPharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK.
Xavier KurzPharmacovigilance and Epidemiology Department, European Medicines Agency, London, UK.
Queen Mary University of London · GBUniversity of Dundee · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectiveTendon rupture can result from fluoroquinolone exposure. The objective of this study was to quantify relative and absolute risk and determine how risk is affected by timing of exposure.

methodsThe UK Health Improvement Network primary care database was used to perform a nested case-control study measuring the association between fluoroquinolone exposure and tendon rupture. Adults with tendon rupture were matched on age, sex, general practice and calendar time to four controls selected from a cohort prescribed systemic fluoroquinolone or co-amoxiclav antibiotics. The relative and absolute risk of tendon rupture with fluoroquinolone exposure was calculated.

resultsCurrent fluoroquinolone exposure was associated with an increased risk of any tendon rupture (adjusted incidence rate ratio [aIRR] 1.61, 95% CI 1.25-2.09) and Achilles tendon rupture (aIRR 3.14, 95% CI 2.11-4.65) that persisted for 60 days. Risk increased with cumulative exposure and was greatest when co-prescribed with oral corticosteroids (aIRR 19.36, 95% CI 7.78-48.19 for Achilles tendon rupture). The adjusted rate difference (aRD) with fluoroquinolone exposure was 2.9 and 2.1 per 10,000 patients for any and Achilles tendon rupture, respectively, and was greatest in people aged ≥ 60 years prescribed concomitant oral corticosteroid therapy (aDR 19.6 for any tendon and 6.6 Achilles tendon rupture per 10,000). No association was seen with co-amoxiclav or statin exposure, or with biceps or other tendon ruptures.

conclusionsRisk of tendon rupture with fluoroquinolones depends on timing, cumulative dose and concomitant exposure to oral corticosteroids. Absolute risk significantly varied by age and concomitant corticosteroid exposure, affecting elderly patients the greatest.

Indexed as

Achilles TendonAdrenal Cortex HormonesAdultAgedAnti-Bacterial AgentsCase-Control StudiesFemaleFluoroquinolonesHumansIncidenceMaleMiddle AgedRiskRupture, SpontaneousTendon InjuriesAdrenal Cortex HormonesAnti-Bacterial AgentsFluoroquinolones

Identifiers

PMID30465300
PMCPMC6394638
OpenAlexW2901540150

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.