Update on Screening Recommendations for Hydroxychloroquine Retinopathy

Kim, Judy E.; Marmor, Michael F.

doi:10.1001/jamaophthalmol.2016.1252

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…The rate of retinopathy was considerably higher with HCQ doses over 5.0 mg/kg ABW [ 18 ]. Following the KPNC study, there has been renewed concern in the USA about the appropriate dosing of HCQ, reflected in the latest AAO guidelines [ 15 , 19 , 23 , 24 ]. Despite the previous IBW-based recommendation [ 16 ], there may have been less concern about HCQ retinopathy in the UK than in the USA, as the RCO had not recommended routine HCQ retinopathy screening prior to 2017 [ 16 , 25 – 27 ].…”

Section: Introductionmentioning

confidence: 99%

Hydroxychloroquine prescription trends and predictors for excess dosing per recent ophthalmology guidelines

et al. 2018

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BackgroundHydroxychloroquine (HCQ) retinopathy may be more common than previously recognized; recent ophthalmology guidelines have revised recommendations from ideal body weight (IBW)-based dosing to actual body weight (ABW)-based dosing. However, contemporary HCQ prescribing trends in the UK remain unknown.MethodsWe examined a UK general population database to investigate HCQ dosing between 2007 and 2016. We studied trends of excess HCQ dosing per ophthalmology guidelines (defined by exceeding 6.5 mg/kg of IBW and 5.0 mg/kg of ABW) and determined their independent predictors using multivariable logistic regression analyses.ResultsAmong 20,933 new HCQ users (78% female), the proportions of initial HCQ excess dosing declined from 40% to 36% using IBW and 38% to 30% using ABW, between 2007 and 2016. Among these, 47% of women were excess-dosed (multivariable OR 12.52; 95% CI 10.99–14.26) using IBW and 38% (multivariable OR 1.98; 95% CI,1.81–2.15) using ABW. Applying IBW, 37% of normal and 44% of obese patients were excess-dosed; however, applying ABW, 53% of normal and 10% of obese patients were excess-dosed (multivariable ORs = 1.61 and 0.1 (reference = normal); both p < 0.01). Long-term HCQ users showed similar excess dosing.ConclusionA substantial proportion of HCQ users in the UK, particularly women, may have excess HCQ dosing per the previous or recent weight-based guidelines despite a modest decline in recent years. Over half of normal-BMI individuals were excess-dosed per the latest guidelines. This implies the potential need to reduce dosing for many patients but also calls for further research to establish unifying evidence-based safe and effective dosing strategies.Electronic supplementary materialThe online version of this article (10.1186/s13075-018-1634-8) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Hydroxychloroquine prescription trends and predictors for excess dosing per recent ophthalmology guidelines

et al. 2018

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“…Hydroxychloroquine (HCQ) is widely used in the treatment of several rheumatic disorders, including rheumatoid arthritis and lupus erythematosus beside other diseases so this medication used by many patients (1). HCQ-induced retinal toxicity, or HCQ retinopathy, is a well-documented side effect of HCQ and is characterized by bilateral bull's-eye maculopathy, which presents as a ring of parafoveal retinal pigment epithelium depigmentation that spares the fovea (2).…”

Section: Introductionmentioning

confidence: 99%

“…HCQ-induced retinal toxicity, or HCQ retinopathy, is a well-documented side effect of HCQ and is characterized by bilateral bull's-eye maculopathy, which presents as a ring of parafoveal retinal pigment epithelium depigmentation that spares the fovea (2). The American Academy of Ophthalmology (AAO) revised the guidelines for screening, including visual field examination, fundus autofluorescence (FAF), multifocal electroretinogram (mfERG), and optical coherence tomography evaluation (1). The most important risk factors for HCQinduced retinal toxicity are high dose and long duration of use, dosage > 5.0 mg/kg dramatically increases both population risk and annual incremental risk, and extreme doses can be exceedingly dangerous, other major factors are concomitant renal disease or use of tamoxifen (3).…”

Section: Introductionmentioning

confidence: 99%

Optical Coherence Tomography Angiography (OCTA) to Detect Retinal Alterations in patients Taking Hydroxychloroquine (HCQ)

Hamed

Ganeb

Azim

et al. 2023

Benha Medical Journal

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Background: Hydroxychloroquine (HCQ) was widely used in the treatment of rheumatoid arthritis. HCQ retinopathy, is a well-documented side effect of HCQ which could be investigated by Optical coherence tomography angiography (OCTA). Purpose: to detect retinal alterations in Rheumatoid arthritis patients taking hydroxychloroquine (HCQ) by OCTA and compare them with a control group. Patients and methods: This prospective cross-sectional study included a total of 80 eyes, 40 eyes of rheumatoid arthritis (RA) patients taking HCQ and 40 eyes of normal healthy individuals with completely normal ophthalmological examination. The patients were further divided into high risk and low risk retinopathy groups according to duration of HCQ use. OCTA imaging was performed via Angiovue software. Results: The patients' superior hemi, inferior hemi, and peri-fovea all showed noticeably decreased deep vascular density. (p<0.05). No significant differences were observed regarding vascular density in the fovea and para fovea. High risk patients demonstrated significantly lower superficial vascular density in whole image, superior hemi, para-fovea, and peri-fovea and also significantly lower deep vascular density in superior hemi and para fovea (p<0.05). Duration of drug use showed significant negative correlations with superficial vascular density in whole image, superior hemi, para fovea and peri fovea also with deep vascular density in whole image, superior hemi, and peri fovea (p<0.05).Conclusion: OCTA could be a tool of value to detect retinal alterations in RA patients taking HCQ at the level of deep vascular density parameters in all patients and in superficial and deep vascular density in high-risk patients.

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Imaging of Hydroxychloroquine Toxicity with Fluorescence Lifetime Imaging Ophthalmoscopy

Sauer

Calvo

Vitale

et al. 2019

Ophthalmology Retina

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Update on Screening Recommendations for Hydroxychloroquine Retinopathy

Cited by 5 publications

References 5 publications

Hydroxychloroquine prescription trends and predictors for excess dosing per recent ophthalmology guidelines

Hydroxychloroquine prescription trends and predictors for excess dosing per recent ophthalmology guidelines

Optical Coherence Tomography Angiography (OCTA) to Detect Retinal Alterations in patients Taking Hydroxychloroquine (HCQ)

Imaging of Hydroxychloroquine Toxicity with Fluorescence Lifetime Imaging Ophthalmoscopy

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