Retinal toxicity in a multinational inception cohort of patients with systemic lupus on hydroxychloroquine.
Cast your vote
You can rate an item by clicking the amount of stars they wish to award to this item.
When enough users have cast their vote on this item, the average rating will also be shown.
Your vote was cast
Thank you for your feedback
Thank you for your feedback
AuthorAlmeida-Brasil, Celline C
Hanly, John G
Clarke, Ann Elaine
Petri, Michelle A
Ginzler, Ellen M
Wallace, Daniel J
Lim, S Sam
van Vollenhoven, Ronald
Kamen, Diane L
Gladman, Dafna D
Fortin, Paul R
Alarcon, Graciela S
Merrill, Joan T
Askanase, Anca D
Bruce, Ian N
Journal titleLupus science & medicine
MetadataShow full item record
AbstractTo evaluate hydroxychloroquine (HCQ)-related retinal toxicity in the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort.
Data were collected at annual study visits between 1999 and 2019. We followed patients with incident SLE from first visit on HCQ (time zero) up to time of retinal toxicity (outcome), death, loss-to-follow-up or end of study. Potential retinal toxicity was identified from SLICC Damage Index scores; cases were confirmed with chart review. Using cumulative HCQ duration as the time axis, we constructed univariate Cox regression models to assess if covariates (ie, HCQ daily dose/kg, sex, race/ethnicity, age at SLE onset, education, body mass index, renal damage, chloroquine use) were associated with HCQ-related retinal toxicity.
We studied 1460 patients (89% female, 52% white). Retinal toxicity was confirmed in 11 patients (incidence 1.0 per 1000 person-years, 0.8% overall). Average cumulative time on HCQ in those with retinal toxicity was 7.4 (SD 3.2) years; the first case was detected 4 years after HCQ initiation. Risk of retinal toxicity was numerically higher in older patients at SLE diagnosis (univariate HR 1.05, 95% CI 1.01 to 1.09).
This is the first assessment of HCQ and retinal disease in incident SLE. We did not see any cases of retinopathy within the first 4 years of HCQ. Cumulative HCQ may be associated with increased risk. Ophthalmology monitoring (and formal assessment of cases of potential toxicity, by a retinal specialist) remains important, especially in patients on HCQ for 10+ years, those needing higher doses and those of older age at SLE diagnosis.
CitationAlmeida-Brasil CC, Hanly JG, Urowitz M, Clarke AE, Ruiz-Irastorza G, Gordon C, Ramsey-Goldman R, Petri MA, Ginzler EM, Wallace DJ, Bae SC, Romero-Diaz J, Dooley MA, Peschken C, Isenberg D, Rahman A, Manzi S, Jacobsen S, Lim SS, van Vollenhoven R, Nived O, Jönsen A, Kamen DL, Aranow C, Sánchez-Guerrero J, Gladman DD, Fortin PR, Alarcon GS, Merrill JT, Kalunian K, Ramos-Casals M, Steinsson K, Zoma A, Askanase AD, Khamashta M, Bruce IN, Inanc M, Lukusa L, Bernatsky S. Retinal toxicity in a multinational inception cohort of patients with systemic lupus on hydroxychloroquine. Lupus Sci Med. 2022 Nov;9(1):e000789. doi: 10.1136/lupus-2022-000789. PMID: 36396267; PMCID: PMC9677013.
The following license files are associated with this item:
- Creative Commons
Except where otherwise noted, this item's license is described as © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
- Retinal Complications in Patients with Systemic Lupus Erythematosus Treated with Antimalarial Drugs.
- Authors: Mukwikwi ER, Pineau CA, Vinet E, Clarke AE, Nashi E, Kalache F, Grenier LP, Bernatsky S
- Issue date: 2020 Apr
- Clinical impact of hydroxychloroquine dose adjustment according to the American Academy of Ophthalmology guidelines in systemic lupus erythematosus.
- Authors: Vázquez-Otero I, Medina-Cintrón N, Arroyo-Ávila M, González-Sepúlveda L, Vilá LM
- Issue date: 2020 May
- Risk factors for hydroxychloroquine retinopathy in systemic lupus erythematosus: a case-control study with hydroxychloroquine blood-level analysis.
- Authors: Lenfant T, Salah S, Leroux G, Bousquet E, Le Guern V, Chasset F, Francès C, Morel N, Chezel J, Papo T, Cacoub P, Mouthon L, Guettrot-Imbert G, Cohen P, Régent A, Mauget-Faÿsse M, Piette JC, Jallouli M, Costedoat-Chalumeau N, PLUS Group
- Issue date: 2020 Dec 1
- The incidence of irreversible retinal toxicity in patients treated with hydroxychloroquine: a reappraisal.
- Authors: Mavrikakis I, Sfikakis PP, Mavrikakis E, Rougas K, Nikolaou A, Kostopoulos C, Mavrikakis M
- Issue date: 2003 Jul
- Evolution of retinal changes measured by optical coherence tomography in the assessment of hydroxychloroquine ocular safety in patients with systemic lupus erythematosus.
- Authors: Martín-Iglesias D, Artaraz J, Fonollosa A, Ugarte A, Arteagabeitia A, Ruiz-Irastorza G
- Issue date: 2019 Apr