Correlation Between Hydroxychloroquine and Retinopathy

A cohort analysis of over 3,000 people who had hydroxychloroquine for 5 years or longer with guideline-recommended serial retinal screening found that the overall risk for incident retinopathy was low, with the majority of documented cases being mild.

A higher hydroxychloroquine dose was linked to a progressively higher risk. The study was published in the Annals of Internal Medicine.

Hydroxychloroquine is recommended for patients with systemic lupus erythematosus and some other inflammatory conditions, but vision-threatening retinopathy is a serious long-term adverse effect. Dosing should be kept to 5 mg/kg of body weight per day or less, according to guidelines. However, the current research evidence is relatively weak.

Researchers from Kaiser Permanente Northern California and Harvard Medical School studied 3,325 people who received hydroxychloroquine for 5 years or more between 2004 and 2020 to characterize the long-term risk for incident hydroxychloroquine retinopathy and to see how well the average hydroxychloroquine dose predicts this risk.

The researchers examined hydroxychloroquine dose in pharmacy and health records and reviewed annual optical scans over time to see if there was evidence of retinopathy. If retinopathy was found, it was graded as mild, moderate, or severe. Following that, the researchers calculated the risk of developing retinopathy after 15 years based on the average dosage levels throughout the first five years.

They discovered that 81 people acquired hydroxychloroquine retinopathy, with overall cumulative incidences of 2.5 and 8.6 percent occurring after 10 and 15 years, respectively, with the risk being higher for those who had a larger dose during the first 5 years of treatment. According to the experts, routine screening can detect this problem at an early and treatable stage.

Reference: Hydroxychloroquine Dose and Risk for Incident Retinopathy, Annals of Internal Medicine (2023). DOI: 10.7326/M22-2453