Abstract
Purpose :
Though generally well-tolerated, hydroxychloroquine (HCQ) use has been associated with central vision loss secondary to retinal toxicity. To limit the risk of developing retinopathy, the American Academy of Ophthalmology (AAO) released amended guidelines in March 2016 that recommended a maximum daily HCQ dosage of ≤ 5.0 mg/kg of real weight. The objective of the following study was to examine HCQ prescribing habits at the University of Virginia prior to and after the release of these guidelines.
Methods :
A single-center retrospective chart review was performed on a total of 200 adult patients who had been on HCQ continuously from 2015 to 2017 through a UVA prescriber. Weight-based dosages were calculated at three time points and stratified into dosing groups. Shifts among dosing groups were noted, along with the contributing factor that led to the shift (either weight and/or dose change).
Results :
Of the 200 patients included in the study, 84 (42%) were prescribed a weight-based dose above the recommended maximum of 5 mg/kg/day for at least one of the time points reviewed. Shifts to higher-risk dosing groups were solely driven by changes in weight in all time frames (N = 9 in 2015-16 vs. 9 in 2016-17). Shifts to lower-risk dosing groups were instead driven more by changes in prescribing habits following the release of the March 2016 guidelines (N = 6 in 2015-16 vs. 14 in 2016-17).
Conclusions :
The study revealed that patients can and will shift to higher levels of retinal toxicity risk even while being maintained on the same HCQ dose. Since real weight remains a better predictor of risk over ideal weight, prescribers should note weight fluctuations especially when adjusting maintenance doses to minimize associated retinopathy risk to the patient.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.