Association between cycline antibiotic and development of pseudotumor cerebri syndrome

Eldweik, Luai; McClelland, Collin M.; Stein, Joshua D.; Blachley, Taylor; Lee, Michael S.

doi:10.1016/j.jaad.2019.03.041

Cited by 12 publications

(6 citation statements)

References 12 publications

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“…In a recent cohort study with controls on cycline antibiotics and IIH development, Eldweik et al. ( 32 ) reported a marginally increased risk; however, this was not significant after adjusting for confounding factors. The OR was slightly increased for antibiotic treatments in comparison with the obese controls, but when excluding risk factor antibiotics, it did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 97%

Infectious and inflammatory disorders might increase the risk of developing idiopathic intracranial hypertension – a national case-control study

et al. 2020

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Objective To investigate whether conditions causing inflammatory activation are associated with increased risk of idiopathic intracranial hypertension. Methods All newly diagnosed idiopathic intracranial hypertension patients (cases) in Sweden between 2000–2016 were identified using pre-determined algorithms (n = 902) and matched with five controls from the general population and five individuals with an obesity diagnosis (n = 4510) for age, sex, region, and vital status. National health registers provided information on infections, inflammatory disorders and dispensed medications. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals. Results Compared to general population controls, the cases had fourfold increased odds of having an infection (odds ratio = 4.3, 95% confidence interval 3.3–5.6), and threefold increased odds of an inflammatory disorder the year prior to idiopathic intracranial hypertension diagnosis (odds ratio = 3.2, 95% confidence interval 2.4–4.3). Organ specific analyses showed that odds were increased for the study diseases in the respiratory organ, kidney organ and gastrointestinal tract, but not for female genital infections. Similar results were found when comparing idiopathic intracranial hypertension with obese controls though the odds ratios were of lower magnitude. Sub-analyses on exposure to anti-infectious and anti-inflammatory drugs confirmed the increased odds ratios for idiopathic intracranial hypertension patients. Conclusions These findings suggest that major inflammatory activation may be a risk factor in idiopathic intracranial hypertension development.

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Section: Discussionmentioning

confidence: 97%

Infectious and inflammatory disorders might increase the risk of developing idiopathic intracranial hypertension – a national case-control study

et al. 2020

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“…Eldweik et al (19) (2019) recently reviewed claims data from a nationwide insurer and found that in an unadjusted, multivariable Cox regression model, there was a 70%–91% increased risk of papilledema or PTCS in tetracycline antibiotic users. After adjusting for confounders, the increased risk was no longer statistically significant.…”

Section: Discussionmentioning

confidence: 99%

“…Eldweik et al (19) (2019) recently reviewed claims data from a nationwide insurer and found that in an unadjusted, multivariable Cox regression model, there Percentages have been rounded for simplicity. Because we acknowledged that our estimate of the incidence of tetracycline-induced pseudotumor cerebri syndrome (PTC-T) was an overestimate, we estimated the number of at-risk patients in the State of Utah.…”

Section: Discussionmentioning

confidence: 99%

Increased Incidence of Pseudotumor Cerebri Syndrome Among Users of Tetracycline Antibiotics

Passi¹,

Butcher²,

Orme³

et al. 2022

Journal of Neuro-Ophthalmology

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Background: To determine whether the use of a tetracycline-class antibiotic is associated with an increased risk of developing pseudotumor cerebri syndrome (PTCS). Methods: We identified patients in the University of Utah Health system who were prescribed a tetracycline-class antibiotic and determined what percentage of those individuals were subsequently diagnosed with PTCS secondary to tetracycline use. We compared this calculation to the number of patients with PTCS unrelated to tetracycline use. Results: Between 2007 and 2014, a total of 960 patients in the University system between the ages of 12 and 50 were prescribed a tetracycline antibiotic. Among those, 45 were diagnosed with tetracycline-induced PTCS. We estimate the incidence of tetracycline-induced PTCS to be 63.9 per 100,000 person-years. By comparison, the incidence of idiopathic intracranial hypertension (IIH) is estimated to be less than one per 100,000 person-years (Calculated Risk Ratio = 178). Conclusions: Although a causative link between tetracycline use and pseudotumor cerebri has yet to be firmly established, our study suggests that the incidence of pseudotumor cerebri among tetracycline users is significantly higher than the incidence of IIH in the general population.

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“…A recent study looking at cycline antibiotics reported an initial increased risk for development of IIH suggesting that the substance could be the risk factor, but when confounders were adjusted for this effect disappeared, and there was no dose-response effect that could strengthen the evidence base (32). When discussing pharmacological treatments as risk factors one must consider the indication why they are used.…”

Section: Factors Associated With Iihmentioning

confidence: 99%

A national Swedish case-control study investigating incidence and factors associated with idiopathic intracranial hypertension

et al. 2021

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Objective To study the incidence of idiopathic intracranial hypertension in Sweden and to explore whether previously proposed risk factors are associated with idiopathic intracranial hypertension by investigating the odds of exposure one year prior to diagnosis in patients compared to controls. Methods Using Swedish health care registers and validated diagnostic algorithms, idiopathic intracranial hypertension patients diagnosed between 2000–2016 were compared with randomly selected matched controls, five from the general population and five with obesity. Results We identified 902 idiopathic intracranial hypertension patients and 4510 matched individuals in each control group. Mean incidence among inhabitants ≥18 years of age was 0.71 per 100,000; rising from 0.53 in 2000–2005 to 0.95 in 2012–2016. There were increased odds for idiopathic intracranial hypertension patients compared to general population for exposure to: kidney failure (odds ratio =13.2 (4.1–42.0)), arterial hypertension (odds ratio =17.5 (10.5–29.3)), systemic lupus erythematosus (odds ratio =13.8 (4.3–44.7)), tetracyclines, sulphonamides, lithium, and corticosteroids. In obese controls, odds ratios were also significantly increased for these exposures. Hormonal contraceptive use and exposure to pregnancy did not appear to be associated factors for idiopathic intracranial hypertension development. Conclusions The incidence of idiopathic intracranial hypertension in Sweden is lower relative to reports from other countries but is on the rise. This case-control study confirms several previously reported risk factors associated with idiopathic intracranial hypertension.

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Association between cycline antibiotic and development of pseudotumor cerebri syndrome

Cited by 12 publications

References 12 publications

Infectious and inflammatory disorders might increase the risk of developing idiopathic intracranial hypertension – a national case-control study

Infectious and inflammatory disorders might increase the risk of developing idiopathic intracranial hypertension – a national case-control study

Increased Incidence of Pseudotumor Cerebri Syndrome Among Users of Tetracycline Antibiotics

A national Swedish case-control study investigating incidence and factors associated with idiopathic intracranial hypertension

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