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Risk Factors for Hydroxychloroquine Retinopathy and Its Subtypes.

April M Jorge1,2, Ronald B Melles3, Michael F Marmor4

  • 1Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston.

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Summary
This summary is machine-generated.

Hydroxychloroquine retinopathy risk increases with age, female sex, CKD, and tamoxifen use. Younger age and male sex are associated with lower risk. Race and ethnicity impact retinopathy patterns.

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Area of Science:

  • Ophthalmology
  • Rheumatology
  • Pharmacology

Background:

  • Hydroxychloroquine is a common medication for autoimmune diseases.
  • Retinopathy is a major toxic effect of hydroxychloroquine.
  • Current guidelines recommend dose limitation and annual screening for retinopathy.

Purpose of the Study:

  • To identify risk factors for hydroxychloroquine retinopathy beyond dose and duration.
  • To inform personalized hydroxychloroquine treatment and monitoring strategies.

Main Methods:

  • A cohort study of 4677 patients was conducted over 15 years.
  • Risk factors including age, sex, race, comorbidities, and concomitant medications were analyzed.
  • Multivariable Cox proportional hazards regression assessed retinopathy risk.

Main Results:

  • Older age, female sex, chronic kidney disease (CKD) stage 3+, and tamoxifen use were associated with increased retinopathy risk.
  • Younger age (<45 years) and male sex were associated with lower risk.
  • Asian and Black patients had a higher likelihood of pericentral retinopathy compared to non-Hispanic White patients.

Conclusions:

  • Individual patient factors significantly influence hydroxychloroquine retinopathy risk.
  • Age, sex, CKD, tamoxifen use, and race/ethnicity should be considered in hydroxychloroquine management.
  • Personalized risk assessment can optimize patient safety and treatment outcomes.