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 - Lim, S Sam
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 - © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
PY - 2022/11
Y1 - 2022/11
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 - Humans
KW - Female
KW - Aged
KW - Male
KW - Hydroxychloroquine/adverse effects
KW - Antirheumatic Agents/adverse effects
KW - Lupus Erythematosus, Systemic/complications
KW - Retinal Diseases/chemically induced
KW - Chloroquine
UR - http://www.scopus.com/inward/record.url?scp=85143398652&partnerID=8YFLogxK
U2 - 10.1136/lupus-2022-000789
DO - 10.1136/lupus-2022-000789
M3 - Journal article
C2 - 36396267
VL - 9
JO - Lupus Science and Medicine
JF - Lupus Science and Medicine
SN - 2053-8790
IS - 1
M1 - 000789
ER -