Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Québec, Canada.
Rheumatology, Dalhousie University, Halifax, Nova Scotia, Canada.
Lupus Sci Med. 2022 Nov;9(1). doi: 10.1136/lupus-2022-000789.
To evaluate hydroxychloroquine (HCQ)-related retinal toxicity in the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort.
Data were collected at annual study visits between 1999 and 2019. We followed patients with incident SLE from first visit on HCQ (time zero) up to time of retinal toxicity (outcome), death, loss-to-follow-up or end of study. Potential retinal toxicity was identified from SLICC Damage Index scores; cases were confirmed with chart review. Using cumulative HCQ duration as the time axis, we constructed univariate Cox regression models to assess if covariates (ie, HCQ daily dose/kg, sex, race/ethnicity, age at SLE onset, education, body mass index, renal damage, chloroquine use) were associated with HCQ-related retinal toxicity.
We studied 1460 patients (89% female, 52% white). Retinal toxicity was confirmed in 11 patients (incidence 1.0 per 1000 person-years, 0.8% overall). Average cumulative time on HCQ in those with retinal toxicity was 7.4 (SD 3.2) years; the first case was detected 4 years after HCQ initiation. Risk of retinal toxicity was numerically higher in older patients at SLE diagnosis (univariate HR 1.05, 95% CI 1.01 to 1.09).
This is the first assessment of HCQ and retinal disease in incident SLE. We did not see any cases of retinopathy within the first 4 years of HCQ. Cumulative HCQ may be associated with increased risk. Ophthalmology monitoring (and formal assessment of cases of potential toxicity, by a retinal specialist) remains important, especially in patients on HCQ for 10+ years, those needing higher doses and those of older age at SLE diagnosis.
评估系统性红斑狼疮国际协作诊所（SLICC）发病队列中羟氯喹（HCQ）相关视网膜毒性。
数据收集于 1999 年至 2019 年的年度研究访视期间。我们对首次接受 HCQ 的新发 SLE 患者进行随访（时间零），直至出现视网膜毒性（结局）、死亡、失访或研究结束。潜在的视网膜毒性通过 SLICC 损害指数评分来识别；通过图表审查来确诊病例。使用累积 HCQ 持续时间作为时间轴，我们构建了单变量 Cox 回归模型，以评估协变量（即 HCQ 日剂量/体重、性别、种族/民族、SLE 发病年龄、教育程度、体重指数、肾脏损害、氯喹使用）是否与 HCQ 相关的视网膜毒性相关。
我们研究了 1460 名患者（89%为女性，52%为白人）。11 名患者确诊为视网膜毒性（发病率为每 1000 人年 1.0 例，总体发生率为 0.8%）。视网膜毒性患者累积 HCQ 时间的平均值为 7.4（SD 3.2）年；第一例在 HCQ 开始后 4 年被发现。SLE 诊断时年龄较大的患者视网膜毒性风险略高（单变量 HR 1.05，95%CI 1.01 至 1.09）。
这是对新发 SLE 患者中 HCQ 和视网膜疾病的首次评估。我们没有在 HCQ 治疗的前 4 年内发现任何视网膜病变的病例。累积 HCQ 可能与风险增加有关。眼科监测（以及由视网膜专家对潜在毒性病例进行正式评估）仍然很重要，尤其是在 HCQ 治疗 10 年以上、需要更高剂量和 SLE 诊断时年龄较大的患者中。
