Hydroxychloroquine Ocular Toxicity: Lessons Learned

Rabin, Jeff; Ramirez, Kirsti

doi:10.3899/jrheum.181375

Cited by 5 publications

(4 citation statements)

References 6 publications

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“…The presence of DISH is associated with older age, male sex, obesity, hypertension, and diabetes mellitus [2,23]. Toyoda et al reported a prevalence of 26%, which increased to 48% in patients over 70 years old [24].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Diffuse Idiopathic Skeletal Hyperostosis on Nutritional Status, Neurological Outcome, and Perioperative Complications in Patients with Cervical Spinal Cord Injury

Shimizu,

Suda,

Harmon

et al. 2023

JCM

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This retrospective study aimed to investigate the characteristics of patients with cervical spinal cord injuries (CSCI) with diffuse idiopathic skeletal hyperostosis (DISH). We included 153 consecutive patients with CSCI who underwent posterior decompression and fusion surgery. The patients were divided into two groups based on the presence of DISH. Patient characteristics, neurological status on admission, nutritional status, perioperative laboratory variables, complications, neurological outcomes at discharge, and medical costs were compared between the groups. The DISH group (n = 24) had significantly older patients (72.1 vs. 65.9, p = 0.036), more patients with low-impact trauma (62.5% vs. 34.1%, p = 0.009), and a lower preoperative prognostic nutritional index on admission (39.8 vs. 42.5, p = 0.014) than the non-DISH group (n =129). Patients with DISH had significantly higher rates of ventilator management (16.7% vs. 3.1%, p = 0.022) and pneumonia (29.2% vs. 8.5%, p = 0.010). There was no significant difference in medical costs and neurological outcomes on discharge. Patients with CSCI and DISH were older, had poor nutritional status, and were prone to postoperative respiratory complications, while no differences were found between the neurological outcomes of patients with CSCI with and without DISH.

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Section: Discussionmentioning

confidence: 99%

The Impact of Diffuse Idiopathic Skeletal Hyperostosis on Nutritional Status, Neurological Outcome, and Perioperative Complications in Patients with Cervical Spinal Cord Injury

Shimizu,

Suda,

Harmon

et al. 2023

JCM

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“…Indeed, detrimental effects for skeletal muscle have been reported after two months of intraperitoneal injection of 10 mg/kg CQ five times per week [58] or after two months of daily subcutaneous injection of 15 mg/kg CQ [59]. HCQ administered at high concentration and too high frequency, induce retinopathy, cardiomyopathy, neuromyopathy and myopathy [42,60]. Searching for a compromise between ethical acceptance in terms of injections number and toxicity of the drug was finally unsuccessful.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, CQ and HCQ are recommended as autophagy inhibitors for the autophagy flux measurement in vitro [8,56,57]. However, doses used and schedule applied should be carefully selected because CQ and to a lesser extent, HCQ, are toxic compounds able to produce vacuolar myopathy [58,59], retinopathy [60], cardiomyopathy and neuromyopathy [42]. As a lysosomotropic drug such as CQ, HCQ allows LC3-II and SQSTM1/p62 to accumulate as a probable result of lysosome deprotonation and/or inhibition of the fusion between lysosome and autophagosome, and the subsequent impairment of autolysosomal degradation [50].…”

Section: Introductionmentioning

confidence: 99%

Long Term Pharmacological Perturbation of Autophagy in Mice: Are HCQ Injections a Relevant Choice?

et al. 2020

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Macroautophagy (hereafter referred to as autophagy) is an evolutionarily conserved catabolic process whose loss-of-function has been linked to a growing list of pathologies. Knockout mouse models of key autophagy genes have been instrumental in the demonstration of the critical functions of autophagy, but they display early lethality, neurotoxicity and unwanted autophagy-independent phenotypes, limiting their applications for in vivo studies. To avoid problems encountered with autophagy-null transgenic mice, we investigated the possibility of disturbing autophagy pharmacologically in the long term. Hydroxychloroquine (HCQ) ip injections were done in juvenile and adult C57bl/6j mice, at range doses adapted from the human malaria prophylactic treatment. The impact on autophagy was assessed by western-blotting, and juvenile neurodevelopment and adult behaviours were evaluated for four months. Quite surprisingly, our results showed that HCQ treatment in conditions used in this study neither impacted autophagy in the long term in several tissues and organs nor altered neurodevelopment, adult behaviour and motor capabilities. Therefore, we recommend for future long-term in vivo studies of autophagy, to use genetic mouse models allowing conditional inhibition of selected Atg genes in appropriate lineage cells instead of HCQ treatment, until it could be successfully revisited using higher HCQ doses and/or frequencies with acceptable toxicity.

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“…The treatment of the ocular manifestation of SLE is usually targeted at reducing ocular tissue damage with the general treatment focusing on the remission of end-organ damage, improving the outcome of the disease in the long run and improving quality of life [148] In SLE, the treatment is deemed effective if the patient has a remission with an SLEDAI score less than 3. Conventionally, SLE is treated with antimalarial drugs, the commonly used one being hydroxychloroquine [194,195]. Long-term hydroxychloroquine may, however, dispose users to retinopathies [196][197][198].…”

Section: Management and Treatmentmentioning

confidence: 99%

Unveiling Ocular Manifestations in Systemic Lupus Erythematosus

Musa,

Chukwuyem,

Ojo

et al. 2024

JCM

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Systemic Lupus Erythematosus (SLE) is a complex autoimmune disorder characterized by immune dysregulation and multi-organ involvement. In this concise brief review, we highlight key insights into Ocular Systemic Lupus Erythematosus (SLE), an intricate autoimmune disorder with diverse organ involvement. Emphasizing the formation of autoantibodies and immune complex deposition, we delve into the inflammation and damage affecting ocular structures. Clinical presentations, ranging from mild dry eye syndrome to severe conditions like retinal vasculitis, necessitate a comprehensive diagnostic approach, including clinical exams, serological testing, and imaging studies. Differential diagnosis involves distinguishing SLE-related ocular manifestations from other autoimmune and non-inflammatory ocular conditions. The multidisciplinary management approach, involving rheumatologists, ophthalmologists, and immunologists, tailors treatment based on ocular involvement severity, encompassing corticosteroids, immunosuppressive agents, and biologics. Follow-up is crucial for monitoring disease progression and treatment response. Future perspectives revolve around advancing molecular understanding, refining diagnostic tools, and exploring targeted therapies. Novel research areas include genetic factors, microbiome composition, and biotechnology for tailored and effective SLE ocular treatments.

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Hydroxychloroquine Ocular Toxicity: Lessons Learned

Cited by 5 publications

References 6 publications

The Impact of Diffuse Idiopathic Skeletal Hyperostosis on Nutritional Status, Neurological Outcome, and Perioperative Complications in Patients with Cervical Spinal Cord Injury

The Impact of Diffuse Idiopathic Skeletal Hyperostosis on Nutritional Status, Neurological Outcome, and Perioperative Complications in Patients with Cervical Spinal Cord Injury

Long Term Pharmacological Perturbation of Autophagy in Mice: Are HCQ Injections a Relevant Choice?

Unveiling Ocular Manifestations in Systemic Lupus Erythematosus

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