“Patients and providers alike are concerned about the risk of hydroxychloroquine retinopathy, and hydroxychloroquine is a very important drug for patients with lupus and other rheumatic diseases.
The pericentral retinopathy pattern has only been recognized in recent years, primarily seen in Asian patients, but also in other racial and ethnic groups.
It is important to better understand each patient’s personalized risk of retinopathy, so this can be weighed against the potential benefits of the medication and help guide treatment,” says April M. Jorge, MD, a rheumatologist at Massachusetts General Hospital in Boston and the study’s co-author.
Spectral domain-optical coherence tomography (SD-OCT) eye scans were taken for all the participants. Each scan was independently reviewed by at least one expert ophthalmologist. All abnormal scans and a subset of normal scans were also reviewed by a second ophthalmologist.
Researchers identified the dates of the earliest abnormal scans, and then, each scan was graded as mild, moderate or severe retinopathy, no retinopathy, or retinopathy not related to hydroxychloroquine. They also classified whether patients had a parafoveal or pericentral pattern to their retinopathy.
Each case of hydroxychloroquine-related retinopathy was matched with up to five control cases by age, sex and the year they started using hydroxychloroquine.
Researchers used pharmacy records to assess the duration of time patients had taken hydroxychloroquine, cumulative and average daily dose of the drug, dose per patient’s actual body weight and ideal body weight.
They also looked at potential risk factors for retinopathy, such as race and ethnicity, and chronic kidney disease, which is a gradual loss of kidney function.
Out of 4,899 long-term users of the drug, 164 patients had incident hydroxychloroquine retinopathy, including 100 mild, 38 moderate and 26 severe cases.
Mean age for patients starting hydroxychloroquine was 56 and over 90% were women. There were 131 patients with a parafoveal pattern of retinopathy and 33 patients with a pericentral pattern.
Retinopathy risk doubled for every additional five years that patients used hydroxychloroquine.
Cumulative dose also increased the risk of retinopathy, as well as increased dose per body weight. Patients with Asian ancestry also had an overall increased risk of retinopathy, as well as eye disease in the moderate or severe grades, and with a pericentral pattern.
Chronic kidney disease was also linked to a two-time higher risk of overall retinopathy and three-time higher risk of moderate or severe retinopathy.
“The study’s findings can help identify people at increased risk of hydroxychloroquine-related retinopathy, and help physicians make individual treatment decisions for their patients,” says Dr. Jorge.
“This also emphasizes the importance of screening for retinopathy among long-term hydroxychloroquine users.”
This research was supported by funding from the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Source: Medindia
