American College of Rheumatology, American Academy of Dermatology, Rheumatologic Dermatology Society, and American Academy of Ophthalmology 2020 Joint Statement on Hydroxychloroquine Use With Respect to Retinal Toxicity

Abstract

Four major medical societies involved with hydroxychloroquine (HCQ) therapy concur on the need for common principles and cooperation to minimize the risk of ocular toxicity. At a daily dosage of ≤5 mg/kg/day actual body weight, the risk of retinal toxicity from HCQ is <2% for usage up to 10 years. Widespread adoption of more sensitive testing techniques, such as optical coherence tomography and automated visual fields, by eye care providers will allow the detection of early toxicity and thus preserve the patient's visual function. Baseline testing is advised to rule out confounding disease when a patient is started on HCQ. Annual screening with sensitive tests should begin no more than 5 years after treatment initiation. Providers should be sensitive to the medical value of HCQ, and not stop the drug for uncertain indications. It is important to note that effective communication among prescribing physicians, patients, and eye care providers will optimize the utility and safety of HCQ.

Adherence to Weight‐Based Dosing Guidelines in Patients Receiving Hydroxychloroquine for Systemic Lupus Erythematosus and Rheumatoid Arthritis: Results of a Quality Improvement Initiative

“…One criticism of these guidelines has been that they do not take into account the clinical nuances of treating patients with SLE ( 8 ), RA, and other rheumatic diseases. That said, a recent multispecialty joint statement (including six rheumatologists) expressed support of the 2016 AAO guidelines while still emphasizing the medication’s importance ( 9 ). Adherence with the AAO guidelines could certainly have unintended consequences, including increased disease activity and loss of other potential benefits from HCQ, including reduced mortality ( 10 ), reduced risk of thrombosis, and reduced metabolic and cardiovascular disease ( 11 ).…”

Systemic toxicity of chloroquine and hydroxychloroquine: prevalence, mechanisms, risk factors, prognostic and screening possibilities

“…Recognition of retinopathy at an early stage, before any retinal pigment epithelium loss, is essential to prevent loss of visual acuity. The latest recommendations suggest initial screening in the first year of treatment but can be done within 5 years [56][57][58]. This first screening must determine the existence of previous retinal lesions.…”

RetINal Toxicity And HydroxyChloroquine Therapy (INTACT): protocol for a prospective population-based cohort study

“…They indicated that there is a critical lack of data from a population-based prospective study on HCQ retinal toxicity. 31 A prospective study to better estimate the risk, risk factors and clinical course of HCQ retinal toxicity is therefore needed.…”