Impact of the 2008 US FDA warnings for fluoroquinolone use in veterans ≥ 60 years of age with lung cancer

Objectives: To evaluate the impact of the United States Food and Drug Administration's 2008 warnings on the use of fluoroquinolones in patients with lung cancer. Methods: The impact of the 2008 FDA warnings on fluoroquinolone use in patients with lung cancer ≥ 60 years old in the VA system (2002-2022) was evaluated. Patients ≥ 60 years of age with lung cancer from January 1, 2002 to December 31, 2022, were included. The number of patients with a fluoroquinolone prescription or inpatient order for each calendar year was standardized as a percentage of newly diagnosed patients. Patients receiving a fluoroquinolone were also evaluated for the concomitant use of corticosteroids and QTc-prolonging medications, which were also standardized as a percentage of newly diagnosed patients. Interrupted time series analyses were used to evaluate the impact of the FDA warnings issued in 2008. The pre-period was 2002-2007, and the post-period was 2009-2022. Results: Statistically significant reductions were observed in fluoroquinolone use for patients with lung cancer aged ≥ 60 years as well as the use of concomitant QTc-prolonging agents. Numerical reductions in the concomitant use of fluoroquinolones and corticosteroids were not statistically significant. Conclusions: The use of fluoroquinolones and concomitant medications associated with safety risks has decreased over time. Healthcare providers caring for veterans with lung cancers have been responsive to the 2008 FDA warnings.