Risk of retinal toxicity in longterm users of hydroxychloroquine
Abstract
OBJECTIVE: Several studies have reported risk factors for hydroxychloroquine (HCQ) retinal toxicity, but data are limited for patients of Asian ancestry. The aim of this study was to investigate the rate of and factors for HCQ retinal toxicity in the Korean population. METHODS: There were 123 patients enrolled in this study who were using or had used HCQ. Retinal toxicity was detected using spectral domain optical coherence tomography, fundus autofluorescence, multifocal electroretinography, and automated visual field testing. Binary logistic regression analysis was performed to identify factors associated with HCQ retinal toxicity. RESULTS: Mean duration of HCQ use and mean HCQ dose in study participants was 10.1 years and 6.4 mg/kg, respectively. We found 17 patients (13.8%) with HCQ retinal toxicity among 123 patients. Patients with retinal toxicity took HCQ ranging from 6.7-21.9 years and daily dosage ranging from 4.9-9.1 mg/kg. Only 1 patient had retinal toxicity among patients with daily dose < 5.0 mg/kg. These factors increased the risk of HCQ retinal toxicity: longer duration of HCQ use [adjusted OR (aOR) = 4.71, 95% CI 2.18-10.15 for duration of HCQ use in 5-yr increments], higher daily HCQ dose (aOR = 3.34, 95% CI 1.03-10.80 for daily HCQ dose in 100-mg increments), and the presence of kidney disease (aOR = 8.56, 95% CI 1.15-64.00). CONCLUSION: HCQ retinal toxicity is associated with duration of HCQ use, daily HCQ dose, and presence of kidney disease. Proper dosing of maximum 5 mg/kg and regular screening according to risk factors are important in HCQ use.
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Major risk factors for hydroxychloroquine retinopathy include duration of treatment, dose, chronic kidney disease and pre-existing retinal or macular disease.
“Major risk factors for retinopathy include duration of treatment (OR 4.71 for every 5 years of use), dose (OR 3.34 for every 100 mg daily dose), chronic kidney disease (adjusted OR 8.56) and pre-existing retinal or macular disease.”
From 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus (2019) · cites this paper as [37]
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- Authors
- Kim, J.-W., Kim, Y. Y., Lee, H., Park, S.-H., Kim, S.-K., & Choe, J.-Y.
- Affiliations
- Daegu Catholic University (KR)
- Venue
- The Journal of Rheumatology
- Publisher
- The Journal of Rheumatology
- Published
- 2017-09-01
- Volume
- 44
- Issue
- 11
- Pages
- 1674-1679
- ISSN
- 0315-162X (ISSN-L)
- 1499-2752
- OpenAlex
- W2753260601
- Cited by
- 63
- References
- 22
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 7 · 2023: 8 · 2022: 7 · 2021: 9 · 2020: 8 · 2019: 8 · 2018: 5 · 2017: 1
- FWCI
- 5.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Rheumatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Ophthalmology › Drug-Induced Ocular Toxicity
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Ophthalmology › Ocular and Laser Science Research
- Keywords
- hydroxychloroquine, retinal toxicity, duration of drug use, daily dose, kidney disease, risk factors, Korean population
- MeSH terms
- Adult, Aged, Dose-Response Relationship, Drug, Female, Humans, Hydroxychloroquine, Male, Middle Aged, Retina, Retinal Diseases, Risk Factors, Antirheumatic Agents, Tomography, Optical Coherence, Republic of Korea
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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