TY - JOUR T1 - Retinal toxicity in a multinational inception cohort of patients with systemic lupus on hydroxychloroquine JF - Lupus Science & Medicine JO - Lupus Sci Med DO - 10.1136/lupus-2022-000789 VL - 9 IS - 1 SP - e000789 AU - Celline C Almeida-Brasil AU - John G Hanly AU - Murray Urowitz AU - Ann Elaine Clarke AU - Guillermo Ruiz-Irastorza AU - Caroline Gordon AU - Rosalind Ramsey-Goldman AU - Michelle A Petri AU - Ellen M Ginzler AU - Daniel J Wallace AU - Sang-Cheol Bae AU - Juanita Romero-Diaz AU - Mary-Anne Dooley AU - Christine Peschken AU - David Isenberg AU - Anisur Rahman AU - Susan Manzi AU - Søren Jacobsen AU - S Sam Lim AU - Ronald van Vollenhoven AU - Ola Nived AU - Andreas Jönsen AU - Diane L Kamen AU - Cynthia Aranow AU - Jorge Sánchez-Guerrero AU - Dafna D Gladman AU - Paul R Fortin AU - Graciela S Alarcon AU - Joan T Merrill AU - Kenneth Kalunian AU - Manuel Ramos-Casals AU - Kristjan Steinsson AU - A Zoma AU - Anca D Askanase AU - Munther Khamashta AU - Ian N Bruce AU - Murat Inanc AU - Luck Lukusa AU - Sasha Bernatsky Y1 - 2022/11/01 UR - http://lupus.bmj.com/content/9/1/e000789.abstract 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.All data relevant to the study are included in the article or uploaded as supplemental information. ER -