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Manlong Xu, Ian M MacDonald; How do RA and SLE patients differ while on long-term hydroxychloroquine therapy?. Invest. Ophthalmol. Vis. Sci. 2021;62(8):193.
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The long-term use of hydroxychloroquine (HCQ) can cause irreversible retinopathy. We performed a prospective study to investigate whether rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) patients differ in their resilience to HCQ toxicity.
Patients with RA and SLE referred to the Eye Institute of Alberta and screened for HCQ retinopathy were identified prospectively over a 20-month period. All patients underwent multifocal electroretinography (mfERG), fundus photography, fundus autofluorescence and spectral-domain optical coherence tomographic (OCT) imaging as part of their visits. Data collected included clinical diagnosis, age, sex, HCQ use (daily dose, total dose, duration of use), co-morbid maculopathy, and tamoxifen use. Patients with co-morbid maculopathy were excluded from the analysis. Patients who received a total dose of ≥2kg of HCQ and had no evidence of retinopathy were a priori referred as the “resilient group”.
A total of 177 patients were recruited in the study; 8 were excluded due to co-morbid maculopathy, leaving 169 (118 RA and 51 SLE) for analysis. Thirty-six patients were in the resilient group. This group had received a significantly higher total dose (2.36±0.45 vs 1.10±0.54 Kg), duration of use (20.01±5.23 vs 10.60±5.11 years), daily dose (4.70±1.53 vs 3.98±1.29 mg/kg body weight), and had a higher proportion of SLE patients (50% vs 25%) compared to the rest of the cohort (all p<0.05). Comparison between RA and SLE patients reveals that the SLE group had received a significantly higher total dose, duration of use, and had a higher percentage of resilient patients (all p<0.05); they were also 5 years younger on average and had more females (both p<0.05). Nevertheless, no significant difference was found in the percentage of resilient patients among different age groups (<50 vs 50-69 vs ≥ 70 years) and between genders (both p>0.05). In terms of HCQ retinopathy cases, the RA group (n=118) had 5 (4.2%) suspect, 1 (0.8%) likely, and 3 (2.5%) confirmed cases of toxicity, whereas, the SLE group (n=51) had only 1 (2.0%) likely case and no suspect or confirmed cases.
While this is a small study, there would appear to be a significant difference between RA and SLE patients as to their relative resilience to HCQ toxicity based on their underlying clinical diagnosis.
This is a 2021 ARVO Annual Meeting abstract.
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