E Williamson1, S Denaxas2, S Morris3, C S Clarke4, M Thomas5, H Evans6, K Direk7, A Gonzalez-Izquierdo7, P Little5, V Lund8, H Blackshaw8, A Schilder8, C Philpott9, C Hopkins10, J Carpenter11, On Behalf Of The Macro Programme Team. 1. Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK; HDR UK, London, UK. 2. HDR UK, London, UK; Institute of Health Informatics, UCL, London, UK. 3. Department of Applied Health Research, University College London, London, UK. 4. Research Department of Primary Care and Population Health, University College London, London, UK. 5. Primary Care and Population Science, University of Southampton, UK. 6. HDR UK, London, UK; Institute of Health Informatics, UCL, London, UK; Ear Institute, UCL, London, UK. 7. Institute of Health Informatics, UCL, London, UK. 8. Ear Institute, UCL, London, UK. 9. Norwich Medical School, University of East Anglia, Norwich, UK; ENT Department, James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK. 10. ENT Department, Guy's and St Thomas' NHS Foundation Trust, London, UK. 11. Department of Medical Statistics, London School of Hygiene.
Abstract
BACKGROUND: Macrolide antibiotics have demonstrated important anti-inflammatory and immunomodulatory properties in chronic rhinosinusitis (CRS) patients. However, reports of increased risks of cardiovascular events have led to safety concerns. We investigated the risk of all-cause and cardiac death, and cardiovascular outcomes, associated with macrolide use. METHODOLOGY: Observational cohort (1997-2016) using linked data from the Clinical Practice Research Datalink, Hospital Episodes Statistics, and the Office for National Statistics. Patients aged 16-80 years with CRS prescribed a macrolide antibiotic or penicillin were included, comparing prescriptions for macrolide antibiotics to penicillin. Outcomes were all-cause mortality, cardiac death, myocardial infarction, stroke, diagnosis of peripheral vascular disease, and cardiac arrhythmia. RESULTS: Analysis included 320,798 prescriptions received by 66,331 patients. There were 3,251 deaths, 815 due to cardiovascular causes, 925 incident myocardial infarctions, 859 strokes, 637 diagnoses of peripheral vascular disease, and 1,436 cardiac arrhythmias. A non-statistically significant trend towards increased risk of myocardial infarction during the first 30 days following macrolide prescription was observed. No statistically significant short- or long-term risks were observed for macrolide prescription. No significant risks were identified for clarithromycin in particular. CONCLUSIONS: Although not statistically significant, our best estimates suggest an increased short-term risk of myocardial infarction in patients with CRS following macrolide prescription, supporting previous observational evidence. However, confounding by indication remains a possible explanation for this apparent increased risk. We found no evidence of longer term increased risks.
BACKGROUND:Macrolide antibiotics have demonstrated important anti-inflammatory and immunomodulatory properties in chronic rhinosinusitis (CRS) patients. However, reports of increased risks of cardiovascular events have led to safety concerns. We investigated the risk of all-cause and cardiac death, and cardiovascular outcomes, associated with macrolide use. METHODOLOGY: Observational cohort (1997-2016) using linked data from the Clinical Practice Research Datalink, Hospital Episodes Statistics, and the Office for National Statistics. Patients aged 16-80 years with CRS prescribed a macrolide antibiotic or penicillin were included, comparing prescriptions for macrolide antibiotics to penicillin. Outcomes were all-cause mortality, cardiac death, myocardial infarction, stroke, diagnosis of peripheral vascular disease, and cardiac arrhythmia. RESULTS: Analysis included 320,798 prescriptions received by 66,331 patients. There were 3,251 deaths, 815 due to cardiovascular causes, 925 incident myocardial infarctions, 859 strokes, 637 diagnoses of peripheral vascular disease, and 1,436 cardiac arrhythmias. A non-statistically significant trend towards increased risk of myocardial infarction during the first 30 days following macrolide prescription was observed. No statistically significant short- or long-term risks were observed for macrolide prescription. No significant risks were identified for clarithromycin in particular. CONCLUSIONS: Although not statistically significant, our best estimates suggest an increased short-term risk of myocardial infarction in patients with CRS following macrolide prescription, supporting previous observational evidence. However, confounding by indication remains a possible explanation for this apparent increased risk. We found no evidence of longer term increased risks.
Authors: Caroline S Clarke; Elizabeth Williamson; Spiros Denaxas; James R Carpenter; Mike Thomas; Helen Blackshaw; Anne G M Schilder; Carl M Philpott; Claire Hopkins; Stephen Morris Journal: BMJ Open Date: 2022-02-08 Impact factor: 2.692
Authors: Romana Haneef; Marie Delnord; Michel Vernay; Emmanuelle Bauchet; Rita Gaidelyte; Herman Van Oyen; Zeynep Or; Beatriz Pérez-Gómez; Luigi Palmieri; Peter Achterberg; Mariken Tijhuis; Metka Zaletel; Stefan Mathis-Edenhofer; Ondřej Májek; Håkon Haaheim; Hanna Tolonen; Anne Gallay Journal: Arch Public Health Date: 2020-06-10