Weill Cornell Medical College, New York City, New York, USA.
Rheumatology, Columbia University Irving Medical Center, New York City, New York, USA.
Lupus Sci Med. 2020 Nov;7(1). doi: 10.1136/lupus-2020-000427.
Hydroxychloroquine (HCQ) retinal toxicity is an ongoing concern for rheumatologists. The revised 2016 American Academy of Ophthalmology (AAO) guidelines created controversy regarding the correct dosing and evaluation of HCQ toxicity. The current study was initiated to further understand rheumatologists' practices regarding HCQ.
A questionnaire-based survey was distributed electronically to rheumatologists. We collected information on HCQ dosing, clinical decision-making processes, familiarity with the AAO 2016 guidelines, and perceived disparities between the AAO 2016 guidelines and rheumatological clinical practice.
78 rheumatologists completed the survey (49% from USA, 90% academic practices, 82% self-identified as lupus experts). Only lupus expert (n=64) data were included in subsequent analysis. The mean cohort size was 747 (50-6571), a total cohort 45 612 patients. HCQ was prescribed to >75% of patients with SLE by 81.3% of SLE experts, with routine counselling about ophthalmic risks. The typical dose of HCQ used was 200-400 mg/day. 17% of rheumatologists use doses up to 600 mg/day, while 6.2% use up to 6.5 mg/kg/day. HCQ adherence is routinely assessed. 479 cases of HCQ retinal toxicity (1.05%) and 9 cases of HCQ-associated blindness (1.8 per 10 000 patients) were reported. 89.1% of respondents reported familiarity with the AAO guidelines. Those aware of the guidelines cited limited dosing options (54.7%), lack of supporting evidence (57.8%) and low patient adherence (43.8%) as obstacles to greater implementation of the guidelines.
These data suggest that HCQ toxicity and blindness are rare in patients with SLE. Rheumatologists treating patients with SLE are aware of the guidelines and appreciate the importance of partnering with ophthalmologists in preventing retinal toxicity.
羟氯喹（HCQ）视网膜毒性一直是风湿病学家关注的问题。修订后的 2016 年美国眼科学会（AAO）指南在 HCQ 毒性的正确剂量和评估方面引起了争议。本研究旨在进一步了解风湿病学家在 HCQ 方面的实践。
我们以电子方式向风湿病学家分发了基于问卷调查的调查。我们收集了关于 HCQ 剂量、临床决策过程、对 2016 年 AAO 指南的熟悉程度以及 AAO 2016 指南与风湿病临床实践之间差异的信息。
78 名风湿病学家完成了调查（49%来自美国，90%为学术实践，82%自认为是狼疮专家）。只有狼疮专家（n=64）的数据被纳入后续分析。平均队列规模为 747（50-6571）例，总队列为 45612 例患者。81.3%的狼疮专家为>75%的 SLE 患者开处方 HCQ，并常规咨询眼科风险。HCQ 的典型剂量为 200-400mg/天。17%的风湿病学家使用高达 600mg/天的剂量，而 6.2%的人使用高达 6.5mg/kg/天的剂量。HCQ 依从性通常会进行评估。报告了 479 例 HCQ 视网膜毒性（1.05%）和 9 例 HCQ 相关失明（每 10000 例患者 1.8 例）。89.1%的受访者表示熟悉 AAO 指南。那些了解指南的人认为剂量选择有限（54.7%）、缺乏支持证据（57.8%）和患者依从性低（43.8%）是更广泛实施指南的障碍。
这些数据表明，SLE 患者的 HCQ 毒性和失明很少见。治疗 SLE 患者的风湿病学家了解这些指南，并认识到与眼科医生合作预防视网膜毒性的重要性。
