Factors Associated with Early Hydroxychloroquine-induced Retinal Toxicity in Patients with Systemic Lupus Erythematosus

Overview

Journal Graefes Arch Clin Exp Ophthalmol

Specialty Ophthalmology

Date 2024 Apr 5

PMID 38578332

Authors

Olga Araujo

Halbert Hernandez-Negrin

Ricardo P Casaroli-Marano

Jose Hernandez-Rodriguez

Alfredo Adan

Gerard Espinosa

Laura Pelegrin

Ricard Cervera

Affiliations

Soon will be listed here.

Abstract

Purpose: Hydroxychloroquine is currently recommended for the treatment of systemic lupus erythematosus (SLE), but it can cause irreversible retinal toxicity. This study aimed to identify factors associated with early hydroxychloroquine-induced retinal toxicity in patients with SLE from a single centre for 20 years.

Methods: SLE patients diagnosed between 1998 and 2017 and followed up for at least 1 year were included. Demographic, clinical, laboratory and therapeutic data were collected from the electronic medical records and retrospectively analysed. Early hydroxychloroquine-induced retinal toxicity was defined as the development of macular toxicity within the first 5 years of hydroxychloroquine treatment.

Results: A total of 345 patients followed for a median of 15 years were analysed; 337 (97.7%) patients received hydroxychloroquine, 38 (11.3%) of them presented with retinal toxicity, and 10 (3%) developed early retinal toxicity. These patients had a mean treatment duration of 3.3 years with a mean cumulative dose of 241 g. Patients were diagnosed by visual field (VF) and fundoscopy, and two were also assessed using spectral domain optical coherence tomography (SD-OCT). The median (IQR) age of patients with early toxicity was 56 (51-66) years, and 80% were female. Factors independently associated with early hydroxychloroquine-induced retinal toxicity were lupus anticoagulant positivity (OR 4.2; 95% CI 1.2-15.5) and hypercholesterolaemia (OR 5.6; 95% CI 1.5-21.5).

Conclusion: Our results suggest that lupus anticoagulant positivity and hypercholesterolaemia among SLE patients may be risk factors for early hydroxychloroquine-induced retinal toxicity, regardless of the dose or duration of treatment.

Citing Articles

Hydroxychloroquine in patients with systemic lupus erythematosus: how much is enough?.

Ruiz-Irastorza G, Paredes-Ruiz D, Arizpe F, Campos-Rodriguez V, Moreno-Torres V, Amo L Lupus Sci Med. 2025; 12(1).

PMID: 40011066 PMC: 11865800. DOI: 10.1136/lupus-2024-001254.

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