From the Université de Montreal; McGill University Health Centre (MUHC), McGill University, Montreal, Quebec; University of Calgary, Calgary, Alberta, Canada.
E.R. Mukwikwi, BSc, Université de Montreal; C.A. Pineau, MD, MUHC, McGill University; E. Vinet, MD, PhD, MUHC, McGill University; A.E. Clarke, MD, MSc, University of Calgary; E. Nashi, MD, PhD, McGill University; F. Kalache, MD, MUHC; L.P. Grenier, MD, MUHC; S. Bernatsky, MD, PhD, MUHC, McGill University.
J Rheumatol. 2020 Apr;47(4):553-556. doi: 10.3899/jrheum.181102. Epub 2019 Sep 1.
Hydroxychloroquine (HCQ) and chloroquine (CQ) are key drugs in systemic lupus (SLE) and related diseases. Retinal toxicity remains the most worrisome complication. We studied factors potentially associated with retinal toxicity, using case-control analyses.
Within our SLE clinic cohort, we identified patients with retinal changes using the Systemic Lupus International Collaborating Clinics Damage Index. We confirmed HCQ/CQ retinopathy with chart review, and selected up to 3 SLE controls for each case, matched by age at SLE diagnosis and SLE duration.
Over an average 12.8 years of followup, within 326 patients exposed to antimalarial drugs, 18 (5.5%) developed retinal toxicity. The minimum number of years of HCQ/CQ exposure before retinopathy developed was 8 years (maximum 33 yrs). Median HCQ/CQ duration was statistically similar in cases [19 yrs, interquartile range (IQR) 14-20] and controls (16 yrs, IQR 11-22), likely due to our matching on SLE duration. Versus controls, cases tended to have more renal disease (cases 22.2%, controls 14.8%) and were slightly less likely to be white (cases 61.1%, controls 74.1%), but neither variable reached statistical significance. Among patients with retinal toxicity, the number previously exposed to CQ was more than 3 times that in controls.
Just over 5% of patients developed antimalarial retinal complications, over an average of 12.8 years. No cases were detected in the first 5 years of therapy. Past CQ use was more common in cases versus controls. Future studies using larger cohorts are under way to better define the roles of therapy duration, race/ethnicity, and other factors.
羟氯喹（HCQ）和氯喹（CQ）是系统性红斑狼疮（SLE）及相关疾病的关键药物。视网膜毒性仍是最令人担忧的并发症。我们使用病例对照分析研究了可能与视网膜毒性相关的因素。
在我们的 SLE 诊所队列中，我们使用系统性红斑狼疮国际合作临床损害指数（Systemic Lupus International Collaborating Clinics Damage Index）识别出有视网膜改变的患者。我们通过病历回顾确认了 HCQ/CQ 视网膜病变，并为每个病例选择了最多 3 名 SLE 对照者，匹配 SLE 诊断年龄和 SLE 持续时间。
在平均 12.8 年的随访中，在 326 名暴露于抗疟药物的患者中，有 18 名（5.5%）发生了视网膜毒性。在发生视网膜病变之前，HCQ/CQ 暴露的最短年限为 8 年（最长 33 年）。病例组 [19 年，四分位距（IQR）14-20] 和对照组 [16 年，IQR 11-22] 的 HCQ/CQ 持续时间中位数在统计学上无显著差异，这可能是由于我们对 SLE 持续时间进行了匹配。与对照组相比，病例组更倾向于患有肾脏疾病（病例组 22.2%，对照组 14.8%），且不太可能是白人（病例组 61.1%，对照组 74.1%），但这两个变量均无统计学意义。在有视网膜毒性的患者中，之前暴露于 CQ 的人数是对照组的 3 倍以上。
超过 5%的患者在平均 12.8 年的时间里出现了抗疟药物的视网膜并发症。在治疗的前 5 年没有发现病例。与对照组相比，病例组过去使用 CQ 的情况更为常见。正在进行使用更大队列的进一步研究，以更好地确定治疗持续时间、种族/民族和其他因素的作用。
