Regular examinations for toxic maculopathy in long-term chloroquine or hydroxychloroquine users

Area of Science:

• Ophthalmology
• Rheumatology
• Pharmacovigilance

Background:

• Long-term use of chloroquine or hydroxychloroquine necessitates regular monitoring for maculopathy.
• Expert guidelines recommend routine eye care visits and diagnostic testing for patients on these medications.

Purpose of the Study:

• To assess the adherence to recommended eye care screening for maculopathy in patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) using chloroquine or hydroxychloroquine.
• To identify factors associated with regular eye care visits among these patients, particularly those at high risk.

Main Methods:

• Retrospective cohort study of RA/SLE patients in a managed care network over 5 years (2001-2011).
• Calculated medication use duration, eye care visits, and diagnostic testing for maculopathy.
• Used logistic regression to analyze factors associated with regular eye care visits, including high-risk status.

Main Results:

• Of 18,051 RA/SLE patients, 1409 (7.8%) used chloroquine/hydroxychloroquine for ≥4 years.
• Among high-risk patients, 27.9% lacked regular eye care visits, and 34.5% had no maculopathy diagnostic testing.
• Each additional month of drug use increased the likelihood of regular eye care (aOR, 1.02). High-risk patients managed by rheumatologists had higher odds of regular eye care (aOR, 1.77).

Conclusions:

• A significant proportion of high-risk patients using chloroquine or hydroxychloroquine do not receive recommended monitoring for maculopathy.
• Suboptimal adherence to expert guidelines highlights a need for further investigation into contributing factors and potential visual outcomes.
• Improved patient monitoring is essential to prevent vision loss associated with these medications.