The challenge: how to maintain therapeutic drug levels in the face of ocular toxicity.
References1. Abdulaziz N, Shah AR, McCune WJ. Hydroxychloroquine: balancing the need to maintain therapeutic levels with ocular safety: an update. Curr Opin Rheumatol. 2018;30:249-255. doi: 10.1097/BOR.0000000000000500.2. Marmor MF, Kellner U, Lai TY, et al; American Academy of Ophthalmology. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology. 2011;118:415-422.3. Marmor MF, Kellner U, Lai TY, et al; American Academy of Ophthalmology. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). Ophthalmology. 2016;123:1386-1394.
Here are the highlights of a recent summary of the current literature on hydroxychloroquine (HCQ) and ocular toxicity.1 What’s new: dosing changes to reduce toxicity and improved techniques that allow earlier detection of retinopathy.
Thumb through the slides for the latest recommendations for HCQ treatment and take-home messages for physicians who treat autoimmune disorders such as lupus.
(Image credit: ©Henrik Dolle/Shutterstock.com)
Note that both HCQ and chloroquine are sequestered in the tissues, where they may remain for up to 5 years.
The incidence of characteristic mfERG abnormalities in those with a cumulative dose of HCQ greater than 1250 g (equivalent to 8.5 years at 400 mg/d) was 41%, versus an incidence of 10% in those with a cumulative dose under 1250 g.
The authors proposed that cumulative dose was more predictive of early subclinical retinopathy than daily dose or duration of treatment.
Objective screening methods recommended in the American Academy of Ophthalmology screening guidelines are multifocal electro-retinography (mfERG), optical coherence tomography (OCT), and fundus auto-fluorescence (FAF).2,3
FAF, fundus auto-fluorescence; mfERG; multifocal electro-retinography; SD-OCT, spectral domain optical coherence tomography.
a Further experience with newer and more sensitive modalities for detection of early toxicity will provide additional data to determine whether a full 5-year interval between the first and second examinations for patients without known risk factors is optimal.