RT Journal Article
SR Electronic
T1 Retinal toxicity in a multinational inception cohort of patients with systemic lupus on hydroxychloroquine
JF Lupus Science & Medicine
JO Lupus Sci Med
FD Lupus Foundation of America
SP e000789
DO 10.1136/lupus-2022-000789
VO 9
IS 1
A1 Celline C Almeida-Brasil
A1 John G Hanly
A1 Murray Urowitz
A1 Ann Elaine Clarke
A1 Guillermo Ruiz-Irastorza
A1 Caroline Gordon
A1 Rosalind Ramsey-Goldman
A1 Michelle A Petri
A1 Ellen M Ginzler
A1 Daniel J Wallace
A1 Sang-Cheol Bae
A1 Juanita Romero-Diaz
A1 Mary-Anne Dooley
A1 Christine Peschken
A1 David Isenberg
A1 Anisur Rahman
A1 Susan Manzi
A1 Søren Jacobsen
A1 S Sam Lim
A1 Ronald van Vollenhoven
A1 Ola Nived
A1 Andreas Jönsen
A1 Diane L Kamen
A1 Cynthia Aranow
A1 Jorge Sánchez-Guerrero
A1 Dafna D Gladman
A1 Paul R Fortin
A1 Graciela S Alarcon
A1 Joan T Merrill
A1 Kenneth Kalunian
A1 Manuel Ramos-Casals
A1 Kristjan Steinsson
A1 A Zoma
A1 Anca D Askanase
A1 Munther Khamashta
A1 Ian N Bruce
A1 Murat Inanc
A1 Luck Lukusa
A1 Sasha Bernatsky
YR 2022
UL http://lupus.bmj.com/content/9/1/e000789.abstract
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.All data relevant to the study are included in the article or uploaded as supplemental information.