The incidence of irreversible retinal toxicity in patients treated with hydroxychloroquine: A reappraisal☆
Section snippets
Patients and methods
This was a prospective cohort study, from 1985 to 2000. It includes 526 consecutive Greek patients with RA (n = 335) and SLE (n = 191), who are or were being treated with HCQ and followed up at the Departments of Clinical Therapeutics and Propaedeutic Medicine, University of Athens, Medical School, Athens, Greece. Criteria for inclusion were continuous and continuing treatment for >1 year with HCQ and accurate drug dosage records. Exclusion criteria were previous exposure to chloroquine and
Results
No HCQ-related retinal toxicity was noted in any of our long-term–treated 400 patients during the first 6 years of treatment or among the remaining 126 patients treated with HCQ for a mean of 3.1 years.
As we have reported previously, 2 (3.4%) of the first 58 studied patients who had completed >6 years of treatment developed toxic maculopathy that was attributable to HCQ.9 The first patient was a 58-year-old woman, with a stable weight of 69 kg during the treatment period, who had received HCQ
Discussion
According to the 2000 Physician’s Desk Reference, the manufacturer of HCQ recommends ophthalmologic examinations every 3 months. Moreover, a recently published survey that examined U.S. rheumatologists’ attitudes toward routine screening for HCQ retinopathy revealed that 94% of them currently screen their patients at least once a year because they are unwilling to accept any risk of visual damage.10 However, the absolute absence of documented cases of HCQ-induced retinopathy in the literature
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Manuscript no. 2109260.
The authors have no proprietary interest in this study.