scholarly journals Accuracy of self-reported risk factors for hydroxychloroquine retinopathy

2021 ◽  
Author(s):  
Christopher M. Santilli ◽  
Amy Garbo Maxey ◽  
Christine A. Lattery ◽  
Emmett F. Carpel ◽  
Karen R. Armbrust
Keyword(s):  
Risk Factors ◽  
Hydroxychloroquine Retinopathy

scholarly journals OP0133 THE PREVALENCE AND RISK FACTORS OF RETINAL TOXICITY ASSOCIATED WITH LONG-TERM HYDROXYCHLOROQUINE USE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 77-78
Author(s):  
S. Do ◽  
J. H. Du ◽  
J. X. An ◽  
J. Wang ◽  
A. Lin
Keyword(s):  
Risk Factors ◽  
Cumulative Dose ◽  
Daily Intake ◽  
Retinal Toxicity ◽  
Factors Associated ◽  
Duration Of Therapy ◽  
Increased Risk ◽  
Hydroxychloroquine Retinopathy ◽  
Risk Of Retinopathy

Background:Hydroxychloroquine (HCQ) is commonly used for the treatment of various autoimmune diseases. The medication is generally well-tolerated. However, long-term use after 5 years may increase the risk of retinopathy. One study in 2014 has demonstrated the risk can be as high as 7.5%. Optical Coherence Tomography (OCT) has become a major modality in screening retinopathy.Objectives:To evaluate the prevalence of retinal toxicity among patients using hydroxychloroquine and to determine various risk factors associated with hydroxychloroquine-associated retinal toxicity.Methods:We performed a retrospective chart review on a cohort of adult patients with long-term use (≥ 5 years cumulative) of HCQ between January 1st, 2011 to December 31st, 2018 from the Kaiser Permanente San Bernardino County and Riverside medical center areas in Southern California, USA. Patients were excluded if they had previously been diagnosed with retinopathy prior to hydroxychloroquine use, were deceased, or had incomplete OCT exam. Our primary endpoint was the prevalence of patients who developed retinal toxicity detected by OCT, and later confirmed by retinal specialist. Potential risk factors (age, duration of therapy, daily consumption per actual body weight, cumulative dose, confounding diseases and medication) for developing retinopathy were also evaluated. Univariable and multivariable logistic regression analyses were used to determine risk factors associated with retinal toxicity.Results:Among 676 patients exposed to more than 5 years of HCQ, the overall prevalence of retinal toxicity was 6.8%, and ranged from 2.5% to 22.2% depending on the age, weight-based dosing, duration of use and cumulative dose. Duration of therapy for 10 years or more increased risk of retinopathy by approximately 5 to 19 folds. Similarly, weight-based dose of 7 mg/kg/day or greater was assciated with increased risk of retinopathy by approximately 5 times. Patients with cumulative dose of 2000 grams or more had greater than 15 times higher risk of developing retinopathy. Duration of use for10 years or more (odd ratio 4.32, 95% CI 1.99 – 12.49), age (odd ratio 1.04; 95% CI 1.01 - 1.08), cumulative dose of more than 1500 g (odd ratio 7.4; 95% CI 1.40 – 39.04) and atherosclerosis of the aorta (odd ratio 2.59; 95% CI, 1.24 – 5.41) correlated with higher risk of retinal toxicity.Conclusion:The overall prevalence of retinopathy was 6.8%. Regular OCT screening, especially in patients with hydroxychloroquine use for more than 10 years, daily intake > 7 mg/kg, or cumulative dose > 1500 grams is important in detecting hydroxychloroquine-associated retinal toxicityReferences:[1]Hobbs HE. Sorsby A, & Freedman A. Retinopathy Following Chloroquine Therapy. The Lancet. 1959; 2(7101): 478-480.[2]Levy, G. D., Munz, S. J., Paschal, J., Cohen, H. B., Pince, K. J., & Peterson, T. Incidence of hydroxychloroquine retinopathy in 1,207 patients in a large multicenter outpatient practice. Arthritis & Rheumatism: 1997; 40(8): 1482-1486.[3]Ding, H. J., Denniston, A. K., Rao, V. K., & Gordon, C. Hydroxychloroquine-related retinal toxicity. Rheumatology. 2016; 55(6): 957-967.[4]Stelton, C. R., Connors, D. B., Walia, S. S., & Walia, H. S. Hydrochloroquine retinopathy: characteristic presentation with review of screening. Clinical rheumatology. 2013; 32(6): 895-898.[5]Marmor, M. F., Kellner, U., Lai, T. Y., Melles, R. B., & Mieler, W. F. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). Ophthalmology. 2016; 123(6): 1386-1394.[6]Melles, R. B., & Marmor, M. F. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA ophthalmology. 2014; 132(12): 1453-1460.Disclosure of Interests:None declared

scholarly journals Frequency and risk factors for hydroxychloroquine retinopathy among patients with systemic lupus erythematosus

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Mohammed Salah Eldin Abdelbaky ◽  
Tarek Ahmad El Mamoun ◽  
Fatma Ibrahim Mabrouk ◽  
Rasha Mohamad Hassan
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Fundus Autofluorescence ◽  
Screening Methods ◽  
Systemic Lupus ◽  
Hydroxychloroquine Retinopathy ◽  
Adults And Children ◽  
Ophthalmological Assessment ◽  
Objective Tool

Abstract Background Hydroxychloroquine (HCQ) is an antimalarial drug, recently used in COVID-19 treatment. Also it is considered over many years the cornerstone in treating systemic lupus erythematosus (SLE) in adults and children. The incidence of retinal affection and retinal toxicity from hydroxychloroquine is rare, but even after the HCQ is stopped, loss of vision may not be reversible and may continue to progress. Fundus autofluorescence (FAF) is one of the screening methods recommended by AAO used for the diagnosis of hydroxychloroquine retinopathy. Our aim is to detect early HCQ-induced retinopathy among SLE patients and the risk factors for its development by using fundus autofluorescence. Results In the present study, 11.3% of the studied patients had significant visual field changes upon testing. Of those, 6.3% had abnormal fundus autofluorescence. We found a significant statistical relation between hydroxychloroquine retinopathy and the duration and cumulative dose of hydroxychloroquine therapy (p value = 0.003) and decreased best-corrected visual acuity of both eyes (p value = 0.000). There was no relationship between HCQ retinopathy detected by fundus autofluorescence and daily dose of HCQ/kg, age, sex, and SLEDAI score. Conclusion Frequency of SLE patients who had confirmed HCQ-induced retinopathy was 6.3%. Hydroxychloroquine could be safely used in all SLE patients regardless of age, sex, and SLE activity. Routine ophthalmological assessment is recommended for SLE patients who received HCQ especially for those who received HCQ longer than 7 years. Fundus autofluorescence is a modern objective tool which is specific for the early detection of HCQ retinopathy.

Implementation of recommendations for the screening of hydroxychloroquine retinopathy: poor adherence of rheumatologists and ophthalmologists

Lupus ◽  
2016 ◽  
Vol 26 (3) ◽  
pp. 277-281 ◽  
Author(s):  
S Shulman ◽  
J Wollman ◽  
S Brikman ◽  
H Padova ◽  
O Elkayam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retinal Toxicity ◽  
Toxicity Screening ◽  
Screening Practices ◽  
Hydroxychloroquine Retinopathy ◽  
Patients At Risk ◽  
Risk Of Disease ◽  
Frequent Testing ◽  
Effective Use

The American Academy of Ophthalmology published in 2011 revised recommendations regarding screening for hydroxychloroquine (HCQ) toxicity. We aimed to assess implementation of these recommendations by rheumatologists and ophthalmologists. A questionnaire regarding screening practices for HCQ toxicity was distributed among all members of the Israeli societies of Rheumatology and Ophthalmology. A total of 128 physicians responded to the questionnaire (rheumatologists: 60, ophthalmologists: 68). Only 5% of the rheumatologists and 15% of the ophthalmologists are aware of ophthalmologic assessments recommended for baseline and follow-up evaluation. When an abnormal test is detected, even if inappropriate for HCQ toxicity screening, 60% of the responders recommend cessation of therapy. Only 13% of the responders recommend first follow-up after five years for patients without risk factors; the remainder recommend more frequent testing. Ninety-six percent of the responders are not aware of all of the known risk factors for HCQ toxicity. Use of inappropriate tests to detect HCQ retinal toxicity may lead to unnecessary cessation of beneficial treatment with risk of disease flare, while lack of consideration of risk factors may put patients at risk for toxicity. These results emphasize the importance of implementing the recommendations to ensure safe and effective use of this drug.

Chloroquine and hydroxychloroquine retinopathy-related risk factors in a Turkish cohort

2013 ◽  
Vol 33 (6) ◽  
pp. 627-634 ◽  
Author(s):  
Sevil Ari Yaylali ◽  
Fariz Sadigov ◽  
Hasan Erbil ◽  
Asiye Ekinci ◽  
Aylin Ardagil Akcakaya
Keyword(s):  
Risk Factors ◽  
Related Risk ◽  
Hydroxychloroquine Retinopathy

scholarly journals P01 Hydroxychloroquine retinopathy: is screening necessary?

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Anne Gobbett ◽  
Jonathan Smith ◽  
Claire Bracewel
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Imaging Techniques ◽  
Central Visual Field ◽  
Screening Guidelines ◽  
Number Of Patients ◽  
Increased Risk ◽  
Hydroxychloroquine Retinopathy ◽  
Serial Images ◽  
Retinopathy Screening

Abstract Background Hydroxychloroquine (HCQ) has long been associated with a low prevalence (0.5%) of retinal toxicity with possible irreversible sight loss. New retinal imaging techniques have suggested a significantly increased prevalence of HCQ retinopathy (7.5%). In light of this result, the American Academy of Ophthalmology (AAO) in 2016 and subsequently the Royal College of Ophthalmologists (RCO) in 2018 produced new screening guidelines. We report the HCQ retinopathy screening results for all patients referred to our Ophthalmology department from 1/11/2017 to date. Methods We collected prospective data from all patients referred for HCQ screening. Patients were screened according to the new RCO guidelines. We recorded each patient's dose and duration of HCQ treatment, their weight and renal function, and concurrent use of tamoxifen to determine their risk factors. Retinal images: colour fundal photos, ocular coherence tomography (OCT) and auto-fluorescence (AF), were performed on all patients (baseline tests), and visual acuity, automated central visual field testing (Humphrey 10:2) and multi focal electroretinography (mfERG) performed as indicated for those at risk, needing annual testing. Results We have diagnosed two definite cases of hydroxychloroquine retinopathy, giving us a prevalence of 2/639 (0.31%) of all screened, and 2/308 (0.64%) of those considered to be at risk according to RCO guidelines. 711 patients have been referred to our screening service so far. 639 of these have been screened with 72 failing to attend. 308 of all those screened have been categorised to be at increased risk of retinopathy: duration of treatment >5 years (224), dose > 5mg/kg/day (40), eGFR< 60ml/min/1.73m2 (111) and use of tamoxifen (0). 64 have multiple risk factors. 119 of those screened have completed their second cycle of screening, with 48 patients failing to attend for this repeat screening. Conclusion Our results for HCQ retinopathy screening suggest a prevalence more in keeping with the originally proposed figure than that in the recent literature; this may be multifactorial. We have a smaller number of patients, with fewer of those patients in the higher risk categories than in the study that prompted the change in screening guidelines. We only have baseline or two years of serial images for each patient at present, the comparison of multiple serial images may highlight more cases of retinopathy. More data is needed before we can suggest our figures are statistically different. Disclosures A. Gobbett None. J. Smith None. C. Bracewell None.

scholarly journals Incidence of and risk factors for chloroquine and hydroxychloroquine retinopathy in Thai rheumatologic patients

2016 ◽  
Vol Volume 10 ◽  
pp. 2179-2185 ◽  
Author(s):  
Nuanpan Tangtavorn ◽  
Yosanan Yospaiboon ◽  
Tanapat Ratanapakorn ◽  
Suthasinee Sinawat ◽  
Thuss Sanguansak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hydroxychloroquine Retinopathy

Elevated level of circulatory sTLT1 induces inflammation through SYK/MEK/ERK signalling in coronary artery disease

2019 ◽  
Vol 133 (22) ◽  
pp. 2283-2299
Author(s):  
Apabrita Ayan Das ◽  
Devasmita Chakravarty ◽  
Debmalya Bhunia ◽  
Surajit Ghosh ◽  
Prakash C. Mandal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Chronic Inflammation ◽  
Ex Vivo ◽  
Human Subjects ◽  
Critical Role ◽  
Atherosclerotic Cardiovascular Disease ◽  
Tnf Α ◽  
Artery Disease

Abstract The role of inflammation in all phases of atherosclerotic process is well established and soluble TREM-like transcript 1 (sTLT1) is reported to be associated with chronic inflammation. Yet, no information is available about the involvement of sTLT1 in atherosclerotic cardiovascular disease. Present study was undertaken to determine the pathophysiological significance of sTLT1 in atherosclerosis by employing an observational study on human subjects (n=117) followed by experiments in human macrophages and atherosclerotic apolipoprotein E (apoE)−/− mice. Plasma level of sTLT1 was found to be significantly (P<0.05) higher in clinical (2342 ± 184 pg/ml) and subclinical cases (1773 ± 118 pg/ml) than healthy controls (461 ± 57 pg/ml). Moreover, statistical analyses further indicated that sTLT1 was not only associated with common risk factors for Coronary Artery Disease (CAD) in both clinical and subclinical groups but also strongly correlated with disease severity. Ex vivo studies on macrophages showed that sTLT1 interacts with Fcɣ receptor I (FcɣRI) to activate spleen tyrosine kinase (SYK)-mediated downstream MAP kinase signalling cascade to activate nuclear factor-κ B (NF-kB). Activation of NF-kB induces secretion of tumour necrosis factor-α (TNF-α) from macrophage cells that plays pivotal role in governing the persistence of chronic inflammation. Atherosclerotic apoE−/− mice also showed high levels of sTLT1 and TNF-α in nearly occluded aortic stage indicating the contribution of sTLT1 in inflammation. Our results clearly demonstrate that sTLT1 is clinically related to the risk factors of CAD. We also showed that binding of sTLT1 with macrophage membrane receptor, FcɣR1 initiates inflammatory signals in macrophages suggesting its critical role in thrombus development and atherosclerosis.

The Preschool Stuttering Screen for Health Care Professionals

2011 ◽  
Vol 21 (2) ◽  
pp. 59-62
Author(s):  
Joseph Donaher ◽  
Christina Deery ◽  
Sarah Vogel
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Differential Diagnosis ◽  
Preschool Children ◽  
Health Care Professionals ◽  
Healthcare Professionals ◽  
Evidence Based ◽  
Developmental Profile

Healthcare professionals require a thorough understanding of stuttering since they frequently play an important role in the identification and differential diagnosis of stuttering for preschool children. This paper introduces The Preschool Stuttering Screen for Healthcare Professionals (PSSHP) which highlights risk factors identified in the literature as being associated with persistent stuttering. By integrating the results of the checklist with a child’s developmental profile, healthcare professionals can make better-informed, evidence-based decisions for their patients.

Clinical Response to Questions Regarding Outcomes and Therapy Efficacy

2010 ◽  
Vol 20 (3) ◽  
pp. 76-83 ◽  
Author(s):  
Joseph Donaher ◽  
Tom Gurrister ◽  
Irving Wollman ◽  
Tim Mackesey ◽  
Michelle L. Burnett
Keyword(s):  
Risk Factors ◽  
Clinical Response ◽  
Speech Language Pathologists ◽  
Specific Therapy ◽  
Therapy Efficacy ◽  
Therapy Program ◽  
Adults Who Stutter ◽  
Cure Rates

Parents of children who stutter and adults who stutter frequently ask speech-language pathologists to predict whether or not therapy will work. Even though research has explored risk-factors related to persistent stuttering, there remains no way to determine how an individual will react to a specific therapy program. This paper presents various clinicians’answers to the question, “What do you tell parents or adults who stutter when they ask about cure rates, outcomes, and therapy efficacy?”

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