Lupus Science and Medicine (Dec 2022)
Retinal toxicity in a multinational inception cohort of patients with systemic lupus on hydroxychloroquine
- Joan T Merrill,
- Munther Khamashta,
- Daniel J Wallace,
- Kenneth Kalunian,
- Susan Manzi,
- Cynthia Aranow,
- Michelle A Petri,
- Rosalind Ramsey-Goldman,
- Ian N Bruce,
- Guillermo Ruiz-Irastorza,
- Ronald van Vollenhoven,
- Ellen M Ginzler,
- Graciela S Alarcón,
- John G Hanly,
- Ann Elaine Clarke,
- Juanita Romero-Diaz,
- Caroline Gordon,
- Sang-Cheol Bae,
- Anisur Rahman,
- Paul R Fortin,
- Dafna D Gladman,
- Kristján Steinsson,
- Ola Nived,
- Andreas Jönsen,
- Manuel Ramos-Casals,
- Murat Inanc,
- Diane L Kamen,
- Søren Jacobsen,
- Jorge Sanchez-Guerrero,
- Murray Urowitz,
- David Isenberg,
- Sasha Bernatsky,
- Luck Lukusa,
- S Sam Lim,
- Anca D Askanase,
- A Zoma,
- Mary-Anne Dooley,
- Christine Peschken,
- Celline C Almeida-Brasil
Affiliations
- Joan T Merrill
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- Munther Khamashta
- 6 Medical Affairs, GSK, Dubai, UAE
- Daniel J Wallace
- Cedars-Sinai/David Geffen School of Medicine at UCLA, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Kenneth Kalunian
- Department of Medicine, UCSD, La Jolla, California, USA
- Susan Manzi
- Allegheny Singer Research Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
- Cynthia Aranow
- Autoimmune and Musculoskeletal Disease, Feinstein Institute for Medical Research Fertility Research Laboratory, Manhasset, New York, USA
- Michelle A Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Rosalind Ramsey-Goldman
- Medicine/Rheumatology, Northwestern University, Evanston, Illinois, USA
- Ian N Bruce
- Arc Epidemiology Unit, The University of Manchester, Manchester, UK
- Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Ronald van Vollenhoven
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
- Ellen M Ginzler
- Medicine/Rheumatology, SUNY Downstate Medical Center, New York, New York, USA
- Graciela S Alarcón
- Medicine, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- John G Hanly
- Rheumatology, Dalhousie University, Halifax, Nova Scotia, Canada
- Ann Elaine Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Juanita Romero-Diaz
- Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Caroline Gordon
- Rheumatology Research Group, University of Birmingham, Birmingham, UK
- Sang-Cheol Bae
- Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology and Hanyang University Institute of Bioscience and Biotechnology, Seoul, Korea
- Anisur Rahman
- Medicine (Rheumatology), University College London, London, UK
- Paul R Fortin
- Medicine-Rheumatology, Universite Laval, Quebec, Quebec, Canada
- Dafna D Gladman
- Schroeder Arthritis Institute and Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
- Kristján Steinsson
- Rheumatology, Department of Obstetrics and Gynecology, Landspitali University Hospital, Reyjavik, Iceland
- Ola Nived
- Department of Clinical Science, Rheumatology, Lund University Faculty of Medicine, Lund, Sweden
- Andreas Jönsen
- Department of Clinical Science, Rheumatology, Lund University Faculty of Medicine, Lund, Sweden
- Manuel Ramos-Casals
- Department of Autoimmune Diseases, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Murat Inanc
- Internal Medicine Rheumatology, Istanbul University, Fatih, Istanbul, Turkey
- Diane L Kamen
- 1 Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Copenhagen University Hospital Center for Rheumatology and Spine Diseases, Copenhagen, Denmark
- Jorge Sanchez-Guerrero
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada
- Murray Urowitz
- Schroeder Arthritis Institute, Krembil Research Institute, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
- David Isenberg
- Medicine (Rheumatology), University College London, London, UK
- Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
- Luck Lukusa
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- S Sam Lim
- 9 Department of Medicine, Division of Rheumatology, Emory University, Atlanta, Georgia, USA
- Anca D Askanase
- Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
- A Zoma
- Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK
- Mary-Anne Dooley
- Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Christine Peschken
- Rheumatology, University of Manitoba, Winnipeg, Manitoba, Canada
- Celline C Almeida-Brasil
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- DOI
- https://doi.org/10.1136/lupus-2022-000789
- Journal volume & issue
-
Vol. 9,
no. 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) 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.
