Session Information
Date: Tuesday, October 23, 2018
Title: Epidemiology and Public Health Poster III: SLE, SSc, APS, PsA, and Other Rheumatic Diseases
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
HCQ is one of the most common DMARD(s) used in treatment of several rheumatologic diseases, including RA and SLE. Although rare, retinal toxicity remains the most feared adverse effect related to HCQ use because it can result in blindness. We conducted a meta-analysis to evaluate the prevalence and risk factors of retinal toxicity in rheumatologic patients on HCQ therapy.
Methods:
We searched PubMed, MEDLINE, Scopus, Embase and Cochrane databases (January 1990 to January 2018) supplemented by manual searches of bibliographies of key relevant articles. We selected for all observational studies in which patients were on HCQ therapy for treatment of a rheumatologic disease, and HCQ retinopathy was evaluated. We calculated the pooled prevalence with the corresponding 95% confidence interval (CI) using the fixed effects method and performed a meta-regression to evaluate the variables that could affect the prevalence.
Results:
After removal of duplicates, our search strategy found 328 studies. Of the 109 studies reviewed, 7 studies met our eligibility criteria, of which 6 studies had appropriate data for quantitative analysis. Of the studies included, 2 were cohort and 4 were nested case-control, comprising of 4112 evaluable patients. The pooled prevalence of HCQ retinopathy was 6% (95% CI 2-10). We found no statistical association (p > 0.05) between the prevalence of retinopathy and the well-known risk factors associated with development of retinopathy, including duration of HCQ use, cumulative dose and daily dose.
Conclusion:
Although HCQ use is infrequently associated with retinopathy, the prevalence is higher than previously documented. Larger studies are needed to better power for the meta-regression of risk factors associated with developing HCQ retinopathy. Ophthalmologic screening should continue to be an important part of the evaluation for all rheumatological patients on HCQ therapy.
Figures/Tables:
Forest plot showing prevalence of HCQ retinopathy
Table showing prevalence data for each study
|
Author (year) |
HCQ users, # |
Retinopathy, # |
No retinopathy, # |
Prevalence, % |
|
Kim et al (2017) |
123 |
17 |
106 |
14 |
|
Eo et al (2017) |
310 |
9 |
301 |
3 |
|
Tangtavorn et al (2016) |
61 |
2 |
59 |
3 |
|
Melles et al (2014) |
2361 |
177 |
2184 |
7 |
|
Kobak et al (2010) |
50 |
8 |
42 |
16 |
|
Levy et al (1997) |
1207 |
1 |
1206 |
0.08 |
Table showing meta-regression of risk factors for HCQ retinopathy
|
|
Beta Coefficient |
P value |
Confidence Interval |
|
Cumulative dose |
1.0001 |
0.14 |
0.9999 – 1.0004 |
|
Daily dose |
1.002 |
0.15 |
0.998 – 1.005 |
|
Duration of use |
0.9998 |
0.38 |
0.9993 – 1.0003 |
|
Age |
1.003 |
0.84 |
0.965 – 1.288 |
To cite this abstract in AMA style:
Worme A, Tamariz L, Palacio A, Nemeth Z, Farbman M. A Meta-Analysis of the Prevalence and Risk Factors for Retinal Toxicity in Rheumatologic Patients on Hydroxychloroquine Therapy [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/a-meta-analysis-of-the-prevalence-and-risk-factors-for-retinal-toxicity-in-rheumatologic-patients-on-hydroxychloroquine-therapy/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-meta-analysis-of-the-prevalence-and-risk-factors-for-retinal-toxicity-in-rheumatologic-patients-on-hydroxychloroquine-therapy/