FREQUENCY OF HYDROXYCHLOROQUINE RELATED MACULOPATHY IN PATIENTS WITH RHEUMATOLOGICAL CONDITIONS: A PROSPECTIVE COHORT STUDY
Main Article Content
Keywords
Hydroxychloroquine, Maculopathy, Rheumatological Conditions, Ophthalmologic Screening, Retinal Toxicity
Abstract
Background: Hydroxychloroquine (HCQ) is commonly prescribed for various rheumatological conditions, including rheumatoid arthritis and systemic lupus erythematosus, due to its anti-inflammatory and immunomodulatory properties. However, prolonged use of HCQ can lead to maculopathy, a serious adverse effect that may result in irreversible vision loss. Regular ophthalmologic screening is recommended to detect early retinal changes indicative of maculopathy.
Objective: This study aims to determine the frequency of HCQ-related maculopathy in patients with rheumatological conditions and identify associated risk factors.
Methods: This prospective cohort study was conducted at the Department of Rheumatology, Lady Reading Hospital, Peshawar from June, 2024 to November, 2024. The study included 303 patients diagnosed with various rheumatological conditions who were treated with HCQ. Data were collected accordingly. The primary outcome was the frequency of HCQ-related maculopathy, diagnosed based on clinical examination and confirmed by fundoscopic and optical coherence tomography (OCT) findings. Statistical analysis was performed using chi-square tests for categorical variables and t-tests for continuous variables, with logistic regression analysis to identify risk factors.
Results: Of the 303 patients, 42 (13.9%) were diagnosed with HCQ-related maculopathy. The mean age of patients with maculopathy was significantly higher than those without (60.2 years vs. 54.3 years, p<0.05). The median duration of HCQ use in patients with maculopathy was longer (8.2 years vs. 6.4 years, p<0.05). Visual acuity impairment and retinal changes were significantly more prevalent in patients with maculopathy compared to those without (73.8% vs. 17.2%, p<0.001 and 81.0% vs. 11.1%, p<0.001, respectively).
Conclusion: Long-term HCQ use is significantly associated with the development of maculopathy in patients with rheumatological conditions. Older age and longer duration of HCQ therapy are key risk factors. Regular ophthalmologic screening is essential to detect early retinal changes and prevent vision loss. Further research is needed to identify additional risk factors and explore safer treatment alternatives.
Objective: This study aims to determine the frequency of HCQ-related maculopathy in patients with rheumatological conditions and identify associated risk factors.
Methods: This prospective cohort study was conducted at the Department of Rheumatology, Lady Reading Hospital, Peshawar from June, 2024 to November, 2024. The study included 303 patients diagnosed with various rheumatological conditions who were treated with HCQ. Data were collected accordingly. The primary outcome was the frequency of HCQ-related maculopathy, diagnosed based on clinical examination and confirmed by fundoscopic and optical coherence tomography (OCT) findings. Statistical analysis was performed using chi-square tests for categorical variables and t-tests for continuous variables, with logistic regression analysis to identify risk factors.
Results: Of the 303 patients, 42 (13.9%) were diagnosed with HCQ-related maculopathy. The mean age of patients with maculopathy was significantly higher than those without (60.2 years vs. 54.3 years, p<0.05). The median duration of HCQ use in patients with maculopathy was longer (8.2 years vs. 6.4 years, p<0.05). Visual acuity impairment and retinal changes were significantly more prevalent in patients with maculopathy compared to those without (73.8% vs. 17.2%, p<0.001 and 81.0% vs. 11.1%, p<0.001, respectively).
Conclusion: Long-term HCQ use is significantly associated with the development of maculopathy in patients with rheumatological conditions. Older age and longer duration of HCQ therapy are key risk factors. Regular ophthalmologic screening is essential to detect early retinal changes and prevent vision loss. Further research is needed to identify additional risk factors and explore safer treatment alternatives.
References
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8. Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol. 2014 Dec;132(12):1453-60.
9. Browning DJ. Hydroxychloroquine and chloroquine retinopathy: Screening for drug toxicity. Am J Ophthalmol. 2002 Sep;134(3):537-43.
10. Mititelu M, Wong BJ, Brenner M, et al. Retinal toxicity associated with chronic exposure to hydroxychloroquine and its ocular screening. JAMA Ophthalmol. 2013;131(4):461-7.
11. Petri M, Orbai AM, Alarcon GS, et al. Hydroxychloroquine in SLE: Blood levels and dosing controversies. J Rheumatol. 2017;44(4):545-51.
12. Leung LS, Neal JW, Wakefield D. Toxic retinopathy associated with hydroxychloroquine therapy: Risk factors, screening, and prevention. Rheumatol Int. 2015;35(4):485-92.
13. Ding HJ, Denniston AK, Rao VK, Gordon C. Hydroxychloroquine-related retinal toxicity. Rheumatology (Oxford). 2016;55(6):957-67.
14. American Academy of Ophthalmology. Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy. Ophthalmology. 2016;123(6):1386-94.
15. Petri M, Purvey S, Fang H, Magder LS. Predictors of hydroxychloroquine retinopathy in SLE patients. Arthritis Rheumatol. 2014;66(3):356-62.
2. Wallace DJ, Gudsoorkar VS, Weisman MH, Venuturupalli SR. New insights into mechanisms of therapeutic effects of antimalarials in SLE. Nat Rev Rheumatol. 2012 Oct;8(9):522-33.
3. Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol. 2014 Dec;132(12):1453-60.
4. Browning DJ. Hydroxychloroquine and chloroquine retinopathy: Screening for drug toxicity. Am J Ophthalmol. 2002 Sep;134(3):537-43.
5. Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler WF. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology. 2011 Feb;118(2):415-22.
6. Rehan-Ullah M, Ahmad M, Bashir MS, Khan MI, Ali MA. Prevalence of rheumatoid arthritis in an urban population of Pakistan. J Coll Physicians Surg Pak. 2017;27(7):428-31.
7. Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler WF. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology. 2016;123(6):1386-94.
8. Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol. 2014 Dec;132(12):1453-60.
9. Browning DJ. Hydroxychloroquine and chloroquine retinopathy: Screening for drug toxicity. Am J Ophthalmol. 2002 Sep;134(3):537-43.
10. Mititelu M, Wong BJ, Brenner M, et al. Retinal toxicity associated with chronic exposure to hydroxychloroquine and its ocular screening. JAMA Ophthalmol. 2013;131(4):461-7.
11. Petri M, Orbai AM, Alarcon GS, et al. Hydroxychloroquine in SLE: Blood levels and dosing controversies. J Rheumatol. 2017;44(4):545-51.
12. Leung LS, Neal JW, Wakefield D. Toxic retinopathy associated with hydroxychloroquine therapy: Risk factors, screening, and prevention. Rheumatol Int. 2015;35(4):485-92.
13. Ding HJ, Denniston AK, Rao VK, Gordon C. Hydroxychloroquine-related retinal toxicity. Rheumatology (Oxford). 2016;55(6):957-67.
14. American Academy of Ophthalmology. Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy. Ophthalmology. 2016;123(6):1386-94.
15. Petri M, Purvey S, Fang H, Magder LS. Predictors of hydroxychloroquine retinopathy in SLE patients. Arthritis Rheumatol. 2014;66(3):356-62.
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Published
Dec 15, 2024
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Muhammad Waqas, Medrarullah Khan, Dr. Farah Rabbani, Muhammad Sajid, Qasim Shah, Tarmeem Lal, Zia Ud Din, & Braikhna Amin. (2024). FREQUENCY OF HYDROXYCHLOROQUINE RELATED MACULOPATHY IN PATIENTS WITH RHEUMATOLOGICAL CONDITIONS: A PROSPECTIVE COHORT STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 1887-1892. https://doi.org/10.53555/4pwwav26
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Author Biographies
Muhammad Waqas
Trainee Medical Officer, Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan
Medrarullah Khan
Trainee Medical Officer, Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan
Dr. Farah Rabbani
Trainee Medical Officer, Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan
Muhammad Sajid
Trainee Medical Officer, Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan
Qasim Shah
Trainee Medical Officer, Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan
Tarmeem Lal
Trainee Medical Officer, Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan
Zia Ud Din
Assistant Professor, Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan
Braikhna Amin
Women Medical Officer, Amin Health Clinic, Peshawar, Pakistan
How to Cite
Muhammad Waqas, Medrarullah Khan, Dr. Farah Rabbani, Muhammad Sajid, Qasim Shah, Tarmeem Lal, Zia Ud Din, & Braikhna Amin. (2024). FREQUENCY OF HYDROXYCHLOROQUINE RELATED MACULOPATHY IN PATIENTS WITH RHEUMATOLOGICAL CONDITIONS: A PROSPECTIVE COHORT STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 1887-1892. https://doi.org/10.53555/4pwwav26