Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA, 02114, USA.
Department of Ophthalmology, Kaiser Permanente, Redwood City, CA, USA.
Arthritis Res Ther. 2018 Jul 5;20(1):133. doi: 10.1186/s13075-018-1634-8.
Hydroxychloroquine (HCQ) retinopathy may be more common than previously recognized; recent ophthalmology guidelines have revised recommendations from ideal body weight (IBW)-based dosing to actual body weight (ABW)-based dosing. However, contemporary HCQ prescribing trends in the UK remain unknown.
We examined a UK general population database to investigate HCQ dosing between 2007 and 2016. We studied trends of excess HCQ dosing per ophthalmology guidelines (defined by exceeding 6.5 mg/kg of IBW and 5.0 mg/kg of ABW) and determined their independent predictors using multivariable logistic regression analyses.
Among 20,933 new HCQ users (78% female), the proportions of initial HCQ excess dosing declined from 40% to 36% using IBW and 38% to 30% using ABW, between 2007 and 2016. Among these, 47% of women were excess-dosed (multivariable OR 12.52; 95% CI 10.99-14.26) using IBW and 38% (multivariable OR 1.98; 95% CI,1.81-2.15) using ABW. Applying IBW, 37% of normal and 44% of obese patients were excess-dosed; however, applying ABW, 53% of normal and 10% of obese patients were excess-dosed (multivariable ORs = 1.61 and 0.1 (reference = normal); both p < 0.01). Long-term HCQ users showed similar excess dosing.
A substantial proportion of HCQ users in the UK, particularly women, may have excess HCQ dosing per the previous or recent weight-based guidelines despite a modest decline in recent years. Over half of normal-BMI individuals were excess-dosed per the latest guidelines. This implies the potential need to reduce dosing for many patients but also calls for further research to establish unifying evidence-based safe and effective dosing strategies.
羟氯喹（HCQ）视网膜病变可能比以前认识到的更为常见；最近的眼科指南已经将建议从理想体重（IBW）剂量修改为实际体重（ABW）剂量。然而，英国目前的 HCQ 处方趋势仍不清楚。
我们在英国一般人群数据库中调查了 2007 年至 2016 年期间 HCQ 的用药剂量。我们研究了眼科指南规定的 HCQ 用药过量的趋势（定义为超过 IBW 的 6.5mg/kg 和 ABW 的 5.0mg/kg），并使用多变量逻辑回归分析确定了其独立预测因素。
在 20933 名新的 HCQ 使用者中（78%为女性），使用 IBW 和 ABW 的初始 HCQ 用药过量比例从 2007 年至 2016 年分别从 40%降至 36%和从 38%降至 30%。其中，47%的女性（IBW 多变量 OR 12.52；95%CI 10.99-14.26）和 38%（ABW 多变量 OR 1.98；95%CI，1.81-2.15）用药过量。应用 IBW 时，37%的正常体重和 44%的肥胖患者用药过量；然而，应用 ABW 时，53%的正常体重和 10%的肥胖患者用药过量（多变量 OR 分别为 1.61 和 0.1（参考=正常体重）；两者均 p<0.01）。长期使用 HCQ 的患者也表现出类似的用药过量。
尽管近年来有所下降，但英国相当一部分 HCQ 使用者，尤其是女性，可能按照以前或最近的体重为基础的指南用药过量。最新指南规定，超过一半的正常 BMI 个体用药过量。这意味着许多患者可能需要减少剂量，但也需要进一步研究，以建立统一的基于证据的安全有效的剂量策略。
