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LetterLetter

Hydroxychloroquine Retinal Toxicity and Its Association with Dosage

Daniel Martín-Iglesias, Joseba Artaraz and Guillermo Ruiz-Irastorza
The Journal of Rheumatology January 2021, 48 (1) 150; DOI: https://doi.org/10.3899/jrheum.200843
Daniel Martín-Iglesias
1Hospital Universitario Cruces, Autoimmune Diseases Research Unit;
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Joseba Artaraz
2Hospital Universitario Cruces, Ophthalmology Department;
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Guillermo Ruiz-Irastorza
1Hospital Universitario Cruces, Autoimmune Diseases Research Unit;
3University of the Basque Country, Medicine, Barakaldo, Spain.
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To the Editor:

A recent clinical image of hydroxychloroquine (HCQ) retinal toxicity has been recently published1. In this case, the patient who presented with symptoms was on long-term treatment with HCQ at more than twice the recommended dose related to her weight, and the tests were consistent with established retinopathy.

HCQ retinopathy has been extensively studied lately. Recent data show an increased risk for toxicity among patients receiving doses > 5 mg/kg/day (i.e., 300 mg/day in a woman of average weight). Otherwise, those taking < 4 mg/kg/day had a frequency of retinopathy < 10% even after more than 20 years of therapy2. A recent study in the Lupus-Cruces cohort found no relevant retinal changes measured by optical coherence tomography over a 5-year follow-up and no cases of established toxicity3. The median dose of HCQ was 3.12 mg/kg/day, with 99% of patients having received < 5 mg/kg/day.

Therefore, clinicians managing patients with systemic lupus erythematosus (SLE) must be aware that HCQ retinal toxicity mostly depends on the daily dose. Treating patients with < 5 mg/kg/day would make those kinds of images a real rarity in the future, assuring long-term treatment as the cornerstone of SLE therapy4.

REFERENCES

  1. 1.↵
    1. Carter KL,
    2. Do DV.
    Hydroxychloroquine-induced retinal toxicity. J Rheumatol 2020;47:632.
    OpenUrlFREE Full Text
  2. 2.↵
    1. Melles RB,
    2. Marmor MF.
    The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol 2014;132:1453-60.
    OpenUrl
  3. 3.↵
    1. Martín-Iglesias D,
    2. Artaraz J,
    3. Fonollosa A,
    4. Ugarte A,
    5. Arteagabeitia A,
    6. Ruiz-Irastorza G.
    Evolution of retinal changes measured by optical coherence tomography in the assessment of hydroxychloroquine ocular safety in patients with systemic lupus erythematosus. Lupus 2019;28:555-9.
    OpenUrl
  4. 4.↵
    1. Fanouriakis A,
    2. Kostopoulou M,
    3. Alunno A,
    4. Aringer M,
    5. Bajema I,
    6. Boletis JN, et al.
    2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis 2019;78:736-45.
    OpenUrlAbstract/FREE Full Text
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Hydroxychloroquine Retinal Toxicity and Its Association with Dosage
Daniel Martín-Iglesias, Joseba Artaraz, Guillermo Ruiz-Irastorza
The Journal of Rheumatology Jan 2021, 48 (1) 150; DOI: 10.3899/jrheum.200843

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Hydroxychloroquine Retinal Toxicity and Its Association with Dosage
Daniel Martín-Iglesias, Joseba Artaraz, Guillermo Ruiz-Irastorza
The Journal of Rheumatology Jan 2021, 48 (1) 150; DOI: 10.3899/jrheum.200843
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