RESEARCH - Plaquenil (hydroxychloroquine) for RA, lupus linked to retinopathy

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Hydroxychloroquine for rheumatoid arthritis, lupus linked to retinopathy

NEW YORK (Reuters Health) Mar 04 - In patients with rheumatoid

arthritis (RA) or systemic lupus erythematosus (SLE), long-term

hydroxychloroquine therapy increases the risk of retinopathy,

according to a February 12th online publication in Arthritis Care &

Research.

For more than half a century, hydroxychloroquine has been widely used

for these conditions, and " through all of this time, a central concern

has been its potential for retinal toxicity, " said the two authors,

Dr. Frederick Wolfe of the National Data Bank for Rheumatic Diseases,

Wichita, Kansas and Dr. F. Marmor of Stanford University in

California.

To help define the risk, they studied 3995 RA or SLE patients who had

used hydroxychloroquine, including 1538 current users (474 with lupus

and 1064 with RA). Patients who reported toxicity were followed up

with detailed interviews and with confirmation by specialists.

Overall, 6.5% of lifetime hydroxychloroquine users discontinued

therapy because of eye problems, and 1.8% did so because or retinal

problems in particular. However, the researchers could document

definite or probable toxicity in only 0.65%.

The risk of toxicity was low in the initial 7 years of exposure but

increased roughly 5-fold after 7 years of use or 1000 grams of total

exposure, the authors said. Toxicity was unrelated to age, weight, or

daily dose.

Most current users had eye exams every 6 months (40.4%) or yearly

(50.5%) to screen for toxicity. Only 2.1% reported never having a

toxicity examination.

The researchers conclude that toxicity " is an infrequent event, even

for long-term users; but the risk becomes increasingly significant

beyond 5-7 years given that the outcome may be irreversible

blindness. "

In email to Reuters Health, Dr. Wolfe commented that " this paper

defines the rate and risk factors for toxicity, and allows for

rational monitoring by physicians. "

Arthritis Care Res 2010.

http://www.medscape.com/viewarticle/717950

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