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Retinal toxicity in a multinational inception cohort of patients with systemic lupus on hydroxychloroquine

Almeida-Brasil, Celline C. ; Hanly, John G. ; Urowitz, Murray ; Clarke, Ann Elaine ; Ruiz-Irastorza, Guillermo ; Gordon, Caroline ; Ramsey-Goldman, Rosalind ; Petri, Michelle A. ; Ginzler, Ellen M. and Wallace, Daniel J. , et al. (2022) In Lupus Science and Medicine 9(1).
Abstract

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)... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
epidemiology, health care, lupus erythematosus, outcome assessment, systemic
in
Lupus Science and Medicine
volume
9
issue
1
article number
000789
publisher
BMJ Publishing Group
external identifiers
  • pmid:36396267
  • scopus:85143398652
ISSN
2053-8790
DOI
10.1136/lupus-2022-000789
language
English
LU publication?
yes
additional info
Publisher Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
id
39c259e9-d20f-45bf-ade0-7cb3a0417bc8
date added to LUP
2022-12-23 10:33:16
date last changed
2024-07-24 04:21:10
@article{39c259e9-d20f-45bf-ade0-7cb3a0417bc8,
  abstract     = {{<p>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.</p>}},
  author       = {{Almeida-Brasil, Celline C. and Hanly, John G. and Urowitz, Murray and Clarke, Ann Elaine and Ruiz-Irastorza, Guillermo and Gordon, Caroline and Ramsey-Goldman, Rosalind and Petri, Michelle A. and Ginzler, Ellen M. and Wallace, Daniel J. and Bae, Sang Cheol and Romero-Diaz, Juanita and Dooley, Mary Anne and Peschken, Christine and Isenberg, David and Rahman, Anisur and Manzi, Susan and Jacobsen, Søren and Sam Lim, S. and Van Vollenhoven, Ronald and Nived, Ola and Jönsen, Andreas and Kamen, Diane L. and Aranow, Cynthia and Sánchez-Guerrero, Jorge and Gladman, Dafna D. and Fortin, Paul R. and Alarcon, Graciela S. and Merrill, Joan T. and Kalunian, Kenneth and Ramos-Casals, Manuel and Steinsson, Kristjan and Zoma, A. and Askanase, Anca D. and Khamashta, Munther and Bruce, Ian N. and Inanc, Murat and Lukusa, Luck and Bernatsky, Sasha}},
  issn         = {{2053-8790}},
  keywords     = {{epidemiology; health care; lupus erythematosus; outcome assessment; systemic}},
  language     = {{eng}},
  month        = {{11}},
  number       = {{1}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{Lupus Science and Medicine}},
  title        = {{Retinal toxicity in a multinational inception cohort of patients with systemic lupus on hydroxychloroquine}},
  url          = {{http://dx.doi.org/10.1136/lupus-2022-000789}},
  doi          = {{10.1136/lupus-2022-000789}},
  volume       = {{9}},
  year         = {{2022}},
}