Hydroxychloroquine Blood Levels Predict Hydroxychloroquine Retinopathy
Open accessAbstract
Objective: In 2016, the American Academy of Ophthalmology ( AAO ) changed the recommended daily dose of hydroxychloroquine ( HCQ ) from 6.5 mg/kg to <5 mg/kg. However, it is not clear that the lower prescribed dose of HCQ will have the same efficacy for systemic lupus erythematosus ( SLE ) activity or the same role in protecting against cardiovascular risk factors and thrombosis. This study was undertaken to address the frequency of HCQ retinopathy and the role of HCQ blood levels in identifying those individuals who are at a greater future risk of retinopathy. Methods: HCQ blood levels in 537 patients with SLE from a large clinical cohort were repeatedly measured, and patients were tested for HCQ retinopathy. We assessed the risk of retinopathy according to clinical characteristics and blood levels of HCQ . Results: The overall frequency of retinopathy was 4.3% (23 of 537 patients). There was a 1% risk of retinopathy in the first 5 years of HCQ treatment, 1.8% from 6 to 10 years, 3.3% from 11 to 15 years, 11.5% from 16 to 20 years, and 8.0% after 21 years of use. We found that older age ( P < 0.0001), higher body mass index ( P for trend = 0.0160), and longer duration of HCQ intake ( P = 0.0024 and P for trend = 0.0006) were associated with a higher risk of HCQ toxicity. Higher blood levels of HCQ predicted later HCQ retinopathy ( P = 0.0124 and P = 0.0340 for mean and maximum HCQ blood levels, respectively). Conclusion: Our data prove the utility of assessing blood levels of HCQ in the prediction of retinopathy. This would allow clinicians to either decrease the dose or increase monitoring in those patients with high HCQ blood levels.
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In a prospective study, the highest tertile of hydroxychloroquine blood levels predicted later retinopathy.
“The highest tertile of hydroxychloroquine blood levels in the prospective study did predict later retinopathy, indicating a role in monitoring blood levels to reduce toxicity (25).”
From Association of Higher Hydroxychloroquine Blood Levels With Reduced Thrombosis Risk in Systemic Lupus Erythematosus (2021) · cites this paper as [25]
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Petri, M., Konig, M. F., Li, J., & Goldman, D. W. (2021) · Arthritis & Rheumatology · doi:10.1002/art.41621 · Cited by 65 · see citing works
“5% using sensitive screening tests, including optical coherence tomography (25).”
BackgroundMethodSelf-citationCarlsson, H., Hjorton, K., Abujrais, S., Rönnblom, L., Åkerfeldt, T., & Kultima, K. (2020) · Arthritis Research & Therapy · doi:10.1186/s13075-020-02211-1 · Cited by 48 · see citing works
- Authors
- Petri, M., Elkhalifa, M., Li, J., Magder, L. S., & Goldman, D. W.
- Affiliations
- Johns Hopkins University (US)
- Alexandria University (EG)
- University of Maryland, Baltimore (US)
- Corresponding author
- Petri, Michelle
- Venue
- Arthritis & Rheumatology
- Publisher
- Wiley
- Published
- 2020-01-07
- Volume
- 72
- Issue
- 3
- Pages
- 448-453
- ISSN
- 2326-5191 (ISSN-L)
- 2326-5205
- PMC
- PMC7050401
- OpenAlex
- W2973996627
- Cited by
- 143
- References
- 39
- Citations by year
- 2026: 13 · 2025: 12 · 2024: 28 · 2023: 15 · 2022: 22 · 2021: 28 · 2020: 25
- FWCI
- 18.40
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Arthritis & Rheumatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01 AR069572)
- Topics
- Health Sciences › Medicine › Ophthalmology › Drug-Induced Ocular Toxicity
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Ophthalmology › Ocular and Laser Science Research
- Keywords
- hydroxychloroquine, retinopathy, drug toxicity, blood concentration, systemic lupus erythematosus, dose reduction, risk prediction, body mass index, duration of drug use, drug monitoring
- MeSH terms
- Adult, Age Factors, Female, Humans, Hydroxychloroquine, Lupus Erythematosus, Systemic, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Retinal Diseases, Risk Factors, Time Factors, Body Mass Index, Treatment Outcome, Antirheumatic Agents
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