Does hydroxychloroquine dose predict the long-term risk of retinopathy?

Hydroxychloroquine is recommended for all patients with systemic lupus erythematosus and is also often used for other inflammatory conditions such as rheumatoid arthritis. However, vision-threatening retinopathy is a critical long-term adverse effect. A new U.S. study aimed to characterize the long-term risk for incident hydroxychloroquine retinopathy. It examined the degree to which the average hydroxychloroquine dose within the first five years of treatment predicts this risk. The cohort study, conducted in a U.S. integrated health network, included all patients (age ≥ 18 years) who received hydroxychloroquine for five or more years between 2004 and 2020. All patients had guideline-recommended serial retinopathy screening. Hydroxychloroquine doses were determined using pharmacy dispensing records. Incident hydroxychloroquine retinopathy was assessed by central adjudication of spectral domain optical coherence tomography, and classified by severity (mild, moderate or severe). Risk for hydroxychloroquine retinopathy was estimated over 15 years of use according to hydroxychloroquine weight-based dose in mg/kg/day (> 6 mg, 5–6 mg, or ≤ 5 mg) using the Kaplan–Meier estimator. Results showed the following: The primary study population included a total of 3,325 patients. Hydroxychloroquine retinopathy developed in 81 patients (56 mild, 17 moderate, 8 severe). Overall cumulative incidences of hydroxychloroquine retinopathy were 2.5% at 10 years and 8.6% at 15 years. The cumulative incidences of retinopathy at 15 years were 21.6% for doses > 6 mg/kg/day, 11.4% for 5–6 mg/kg/day doses, and 2.7% for ≤ 5 mg/kg/day doses. The risks for moderate to severe retinopathy at 15 years were 5.9% for doses > 6 mg/kg/day, 2.4% for 5–6 mg/kg/day doses, and 1.1% for ≤ 5 mg/kg/day doses. The authors concluded that in this large cohort study with active retinopathy screening, the overall risk for hydroxychloroquine retinopathy was 8.6% after 15 years, but most cases were mild. Higher hydroxychloroquine dose was associated with a progressively greater risk for incident retinopathy. Reference 1. Melles RB, Jorge AM, Marmor MF, et al. Hydroxychloroquine dose and risk for incident retinopathy. A cohort study. Ann Intern Med 2023; published online January 17, 2023.

Does hydroxychloroquine dose predict the long-term risk of retinopathy?

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