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Melisa Nika, Taylor Blachley, Paul Edwards, Paul Lee, Joshua Stein; Are Chronic Users of Chloroquine or Hydroxychloroquine Undergoing Regular Visits to Eye Providers and Diagnostic Testing to Check for Maculopathy?. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4387.
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To determine whether patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who are receiving chronic treatment with chloroquine (CQ) or hydroxychloroquine (HCQ) are regularly visiting eye care providers and undergoing screening tests to check for toxic maculopathy.
Claims data of all persons with RA or SLE who were chronic users of CG or HCG and were continuously enrolled for ≥5 years in a large U.S. managed-care network were reviewed to determine the proportion of enrollees with these conditions who visited an eye care provider and underwent diagnostic testing (visual field (VF) testing , optical coherence tomography (OCT)) to check for toxic maculopathy during the period of Jan. 1, 2001 through Dec. 31, 2011 and the frequency of these examinations. Logistic regression was performed to identify factors associated with use of eye care services among chronic CQ or HCQ users.
Among 52285 persons with RA or SLE who met the inclusion criteria, 27091 (51.8%) enrollees had ≥1 record of CQ or HCQ use and 1262 enrollees (2.4%) were taking these medications for ≥ 4 of the 5 years. Among the 1262 highest users of CQ or HCQ, 63.4-69.8% had eye provider visits in a given year and 91.6% had ≥1 eye visit over the 5 year period. Among this highest users of CQ or HCQ, 33.1%-37.1% underwent VF testing in a given year, 2.8-5.5% underwent OCT testing in a given year, 33.8-38.9% underwent ≥1 of any diagnostic test in a given year, and 64.7% underwent ≥1 of any of these diagnostic tests over the 5 year period. Among the highest users of CQ and HCQ, for every additional year of age, the odds of undergoing an eye visit increased 4% (adjusted OR =1.04,95% CI 1.02-1.05) and those under the care of rheumatologists for their RA/SLE had a 142% increased odds of visiting an eye provider (OR=2.42, CI 1.63-3.47) compared to those managed by other providers. Among users of CQ and HCQ, a total of 875 enrollees (3.2%) were diagnosed with ICD-9 codes for “toxic maculopathy” and/or “Plaquenil toxicity”.
In a given year, only two thirds of the highest users of CQ or HCQ for RA or SLE visit an eye care provider and only a third undergo testing to look for signs of medication toxicity. These data suggest a need for better education of clinicians prescribing CQ and HCQ as to the need for monitoring for ocular side effects.
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