Hydroxychloroquine in the treatment of sarcoidosis-associated uveitis and idiopathic uveitis

Uveitis is a major cause of blindness in developed countries, and adverse effects associated with long-term use of topical or systemic steroids and immunosuppressive agents are notable. This study aimed to evaluate the efficacy and safety of hydroxychloroquine (HCQ) in sarcoidosis-associated uveitis (SAU) and idiopathic uveitis (IdU).

This monocentric retrospective study included 42 patients with SAU and 15 patients with IdU treated with HCQ for at least six months between March 2003 and December 2022. All types of uveitis were included. Most patients had chronic bilateral granulomatous SAU or IdU. Efficacy was determined by the success rate of HCQ at 6 and 12 months, and at the last visit and was defined as having control of inflammation, no more than 5 mg prednisone daily and less than or equal to 2 drops of dexamethasone phosphate 0.1%, and no treatment failure due to safety. Biomicroscopic data, best-corrected visual acuity, inflammation grading (SUN criteria) and optionally data from optical coherence tomography and fluorescein or indocyanine green angiography were assessed. The Fisher's exact test and the Wilcoxon rank test were used for the comparison of qualitative data and quantitative data respectively. Prednisone dose was compared using a mixed model.

The median [IQR] duration to the last visit was 19.5 [11-44.8] months in SAU patients and 18 [13-38] months in IdU patients. At the last visit, 55% of patients with SAU (including 70% of anterior SAU and 77% of intermediate SAU) and 40% patients with IdU (including 27% of anterior IdU) were successfully treated with HCQ ; the median [IQR] prednisone dose decreased from 10 [8.0-27.5] to 4 [2.5-5.75] mg/day and from 15.5 [12.5-19.5] to 3.0 [3.0-5.0] mg/day in SAU and IdU patients, respectively. The reduction in median prednisone dose was significant in patients with SAU (p = 0.002). The incidence rate ratio of flare was 0.73 (p = 0.143) in SAU patients and 0.26 (p < 0.001) in IdU patients.

HCQ could be an interesting therapeutic option for specific types of SAU and IdU. Additionally, HCQ decreased the incidence of flare-ups and the need for oral prednisone in these patients.