TY - JOUR
T1 - Retinal toxicity in a multinational inception cohort of patients with systemic lupus on hydroxychloroquine
AU - Almeida-Brasil, Celline C.
AU - Hanly, John G.
AU - Urowitz, Murray
AU - Clarke, Ann Elaine
AU - Ruiz-Irastorza, Guillermo
AU - Gordon, Caroline
AU - Ramsey-Goldman, Rosalind
AU - Petri, Michelle A.
AU - Ginzler, Ellen M.
AU - Wallace, Daniel J.
AU - Bae, Sang Cheol
AU - Romero-Diaz, Juanita
AU - Dooley, Mary Anne
AU - Peschken, Christine
AU - Isenberg, David
AU - Rahman, Anisur
AU - Manzi, Susan
AU - Jacobsen, Søren
AU - Sam Lim, S.
AU - Van Vollenhoven, Ronald
AU - Nived, Ola
AU - Jönsen, Andreas
AU - Kamen, Diane L.
AU - Aranow, Cynthia
AU - Sánchez-Guerrero, Jorge
AU - Gladman, Dafna D.
AU - Fortin, Paul R.
AU - Alarcon, Graciela S.
AU - Merrill, Joan T.
AU - Kalunian, Kenneth
AU - Ramos-Casals, Manuel
AU - Steinsson, Kristjan
AU - Zoma, A.
AU - Askanase, Anca D.
AU - Khamashta, Munther
AU - Bruce, Ian N.
AU - Inanc, Murat
AU - Lukusa, Luck
AU - Bernatsky, Sasha
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
PY - 2022/11/17
Y1 - 2022/11/17
N2 - Objective To evaluate hydroxychloroquine (HCQ)-related retinal toxicity in the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. Methods 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. Results 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). Conclusions 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.
AB - Objective To evaluate hydroxychloroquine (HCQ)-related retinal toxicity in the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. Methods 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. Results 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). Conclusions 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.
KW - epidemiology
KW - health care
KW - lupus erythematosus
KW - outcome assessment
KW - systemic
U2 - 10.1136/lupus-2022-000789
DO - 10.1136/lupus-2022-000789
M3 - Article
C2 - 36396267
AN - SCOPUS:85143398652
SN - 2053-8790
VL - 9
JO - Lupus Science and Medicine
JF - Lupus Science and Medicine
IS - 1
M1 - 000789
ER -