New Study Highlights Risks for Hydroxychloroquine Retinopathy

Hydroxychloroquine Retinopathy and my ABCDEFG Memory Tool

If you’ve followed my discussions and topics for a while now, you’ll probably have come to see that hydroxychloroquine retinopathy is something I talk about fairly often. Please consider reviewing the following links if interested.

Jorge AM et al. 2023

A new study set out to identify risk factors for hydroxychloroquine retinopathy. The researchers evaluated 4,677 long-term hydroxychloroquine users. This included 83 % females and 13 % males. The mean age at the start of hydroxychloroquine treatment was 52 years. There were 125 patients that developed hydroxychloroquine retinopathy within 15 years (102 parafoveal, 23 pericentral).

The following were the risk factors for developing hydroxychloroquine retinopathy:

a) Older age at time of hydroxychloroquine initiation

The adjusted hazard ratios (HRs) were 2.48 (95% CI, 1.28-4.78) for those aged 45 to 54 years, 3.82 (95% CI, 2.05-7.14) for those aged 55 to 64 years, and 5.68 (95% CI, 2.99-10.79) for those aged 65 years or older compared with those younger than 45 years.

b) Females

The risk of retinopathy was higher among females than males (HR, 3.83 [95% CI, 1.86-7.89])

c) Chronic Kidney Disease

The risk of retinopathy was higher among patients with chronic kidney disease stage 3 or greater (HR, 1.95 [95% CI, 1.25-3.04]) compared to lower stages

d) Tamoxifen Use

The risk of retinopathy was higher and among individuals with tamoxifen use (HR, 3.43 [95% CI, 1.08-10.89]).

e) Race

The likelihood of pericentral retinopathy was higher among Asian patients (HR, 15.02 [95% CI, 4.82-46.87]) and Black patients (HR, 5.51 [95% CI, 1.22-24.97]) compared with non-Hispanic White patients.

Conclusions and Comments

This was an interesting study and adds to our growing body of literature highlighting the risk factors for hydroxychloroquine retinopathy. Many of the risks shown in this study are not new but this study captures the magnitude of the risk in ways that not all prior studies could. I use the ABCDEFG memory tool in my practice to capture the risk factors associated with hydroxychlorquine retinopathy:

A = Age

B = Black and Asian patients

C = Cancer drugs (mainly tamoxifen)

D = Duration and Dose of the drug

E = Eye diseases (ie prior macular disease makes screening more difficult)

F = Females

G = Glomerular filtration (ie chronic kidney disease).

REFERENCES

Jorge AM et al. Risk Factors for Hydroxychloroquine Retinopathy and Its Subtypes. JAMA Netw Open. 2024 May 1;7(5):e2410677.