Risk factors of the antimalarial drug's maculopathy: retrospective study in 3580 patients’ cohort.

Abstract

Purpose : Antimalarial drug are widely prescribed to treat systemic lupus erythematosus, rheumatoid arthritis and other connective tissue disease, and also for the antimalarial prevention. The incidence of the maculopathy is about 1% to 5 years. The main risk factor is the cumulative dose. The daily overdose has also been involved. Some risk factor are conventionally referred, including: age over 60 years, renal or hepatic failure, high body mass index (BMI), and a preexisting retinopathy. The objective of this study is to analyze the statistical value of theses classical risk factors.

Methods : This retrospective study was realized from 1.01.2009 to 1.01.2013, in cohort of 3580 patients treated by antimalarial drug. The diagnostic of toxic maculopathy was retained if at least two exams among ocular fundus, macular autofluorescence, central visual field, sd optical tomography, and multifocal electrophysiology, showed compatible signs with the diagnosis. Correlations with the molecule's nature, and classical risk factors were analyzed.

Results : 55 patients had a toxic maculopathy after a treatment period from 3 to 20 years. The cumulative dose differed statistically between chloroquine (CQ)( 633±198 grams) and hydroxychloroquine (HCQ)(1681±413 grams, p=0.02). Daily overdose has been found for 2 patients with HCQ and one patient with CQ. High BMI has been found for 3 patients(OR = 1,1). 4 patients had an elevated serum creatinine, 2 patients had elevated serum transaminases(OR = 1,5). 3 patients had a preexisting retinopathy(OR = 1,4). Monitoring for 2 years didn't showed a poor outcome for theses 3 patients.

Conclusions : Two thirds of the patients exhibiting a toxic maculopathy didn't have any classical risk factors. The presence of a preexisting retinopathy ,that can interfere with early diagnosis, didn't appear like an evolving risk factor.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.