ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 0869

Retinal Toxicity in a Multinational Inception Cohort of Systemic Lupus Patients on Hydroxychloroquine

Celline Almeida-Brasil1, John Hanly2, Murray Urowitz3, Ann Clarke4, Rosalind Ramsey-Goldman5, Caroline Gordon6, Michelle Petri7, Ellen M Ginzler8, Daniel J Wallace9, Sang-Cheol Bae10, Juanita Romero-Díaz11, Mary Ann Dooley12, Christine A. Peschken13, David Isenberg14, Anisur Rahman14, Susan Manzi15, Søren Jacobsen16, S. Sam Lim17, Ronald Van Vollenhoven18, Ola Nived19, Andreas Jönsen19, Diane Kamen20, Cynthia Aranow21, Guillermo Ruiz-Irastorza22, Jorge Sanchez-Guerrero23, Dafna Gladman24, Paul Fortin25, Graciela Alarcón26, Joan Merrill27, Kenneth Kalunian28, Manuel Ramos-Casals29, Kristjan Steinsson30, Asad Zoma31, Anca Askanase32, Munther Khamashta33, Ian Bruce34, Murat Inanc35 and Sasha Bernatsky36, 1McGill University, Montreal, Canada, 2QEII Health Sciences Centre, Halifax, Canada, 3University Health Network, University of Toronto, Toronto, ON, Canada, 4University of Calgary, Calgary, Canada, 5Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, 6University of Birmingham, Birmingham, England, United Kingdom, 7Johns Hopkins University School of Medicine, Baltimore, 8SUNY Downstate Health Sciences University, Brooklyn, 9Cedars-Sinai Medical Center, Beverly Hills, CA, 10Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea, 11Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico, 12UNC Health, Chapel Hil, 13University of Manitoba, Winnipeg, Canada, 14University College London, London, United Kingdom, 15Temple University, Philadelphia, 16University of Copenhagen, Copenhagen, Denmark, 17Emory University, Atlanta, GA, 18University of Amsterdam, Amsterdam, Netherlands, 19Lund University, Lund, Sweden, 20Medical University of South Carolina, Charleston, SC, 21Feinstein Institutes for Medical Research, Manhasset, NY, 22Hospital Universitario Cruces, Barakaldo, Spain, 23University of Toronto, Toronto, Canada, 24Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada, 25CHU de Quebec - Universite Laval, Quebec, Canada, 26Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, The University of Alabama at Birmingham; Department of Medicine, School of Medicine; Universidad Peruana Cayetano, Heredia, Alabama, 27New York University, New York, 28University of California San Diego, La Jolla, CA, 29University of Barcelona, Barcelona, Spain, 30Reykjavik University, Reykjavik, Iceland, 31University of Glasgow, Glasgow, United Kingdom, 32Columbia University College of Physicians & Surgeons, New York, NY, 33King's College London, London, United Kingdom, 34The University of Manchester, Manchester, United Kingdom, 35Department of Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey, 36The Research Institute of the McGill University Health Centre, Montreal, ON, Canada

Meeting: ACR Convergence 2020

Keywords: , , , ,

Session Information

Date: Saturday, November 7, 2020

Title: SLE – Treatment Poster I

Session Type: Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Despite the beneficial effects of hydroxychloroquine (HCQ) in systemic lupus erythematosus (SLE), retinal toxicity is a concern. Factors associated with retinal toxicity have been studied among long-term HCQ users but have not been described for incident SLE patients. We evaluated the incidence of HCQ-related retinal toxicity in a large, international, inception cohort of SLE patients, and assessed factors potentially associated with this event.

Methods: We analyzed prospective data from the Systemic Lupus International Collaborating Clinics (SLICC) cohort, that includes SLE patients from 33 sites in Europe, Asia, and North America, enrolled within 15 months of diagnosis. Using annual study visits between 1999-2019, we followed patients from first visit on HCQ (time zero/baseline) up to the time of retinal toxicity documentation (outcome) or death, loss to follow-up, or censoring at end of study interval. Retinal toxicity was identified based on the SLICC/ACR damage index item for retinal damage and cases were confirmed with chart review. Multivariable Cox regression was used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for baseline factors potentially associated with retinal toxicity (i.e., sex, race/ethnicity, age at SLE onset, HCQ daily dose/kg, body mass index, and smoking). We also plotted a Kaplan-Meier curve for probability of retinal toxicity related to total duration of HCQ therapy.

Results: A total of 1460 patients (89% female, 52% Caucasian) were included. Mean SLE duration at time zero (HCQ initiation) was 2.4 (standard deviation, SD 2.2) years and patients remained on HCQ an average of 6.4 (SD 4.2) years. Retinal toxicity was confirmed for 11 patients (incidence 1.0 per 1000 person-years) at a mean of 8.8 (SD 4.0) years. Our hazards regression model (Table 1) identified non-significant trends for greater risk in men, black patients, those receiving more than 5 mg per kg at baseline, overweight patients and smokers. In the Kaplan-Meier curve (Figure 1), the crude probability of retinal toxicity was less than 1% until 10 years of cumulative HCQ use, but increased around 1% each year after that, reaching 5% after 14 years.

Conclusion: In recent-onset SLE patients receiving HCQ, the probability of retinal toxicity increases after 10 years of cumulative use. There were non-significant trends for greater risk in men, black patients, those receiving more than 5 mg per kg at baseline, overweight patients and smokers. More sophisticated analyses with time-dependent variables are under way.

Table 1. Uni and multivariable Cox regression for retinal toxicity in HCQ-exposed SLE patients

Figure 1. Kaplan-Meier curve for cumulative probability of retinal toxicity. The shaded areas represent pointwise 95% confidence intervals.

Disclosure: C. Almeida-Brasil, None; J. Hanly, None; M. Urowitz, None; A. Clarke, AstraZenca, 5, Exagen Diagnostics, 5; R. Ramsey-Goldman, None; C. Gordon, UCB, 1, 2, 3, 4, CDC, 1, MGP, 1; M. Petri, AbbVie, 5, Amgen, 5, AstraZeneca, 2, 5, BMS, 5, Decision Resources, 5, GSK, 2, 5, INOVA, 5, IQVIA, 5, Janssen, 5, Eli Lilly, 2, 5, Merck EMD Serono, 5, Sanofi Japan, 5, Thermofisher, 5, UCB, 5, Exagen, 2; E. Ginzler, Aurinia Pharmaceuticals, Inc., 2; D. Wallace, Exagen, 1, 2, Exagen, 1, 2; S. Bae, None; J. Romero-Díaz, Biogen, 5; M. Dooley, None; C. A. Peschken, None; D. Isenberg, None; A. Rahman, None; S. Manzi, None; S. Jacobsen, BMS, 2; S. Lim, None; R. Van Vollenhoven, None; O. Nived, None; A. Jönsen, None; D. Kamen, None; C. Aranow, None; G. Ruiz-Irastorza, None; J. Sanchez-Guerrero, None; D. Gladman, AbbVie, 2, 5, Amgen, 2, 5, Janssen, 2, 5, Novartis, 2, 5, Pfizer, 2, 5, UCB, 2, 5, Bristol-Myers Squibb, 5, Gilead, 5, Galapagos, 5, Celgene, 2, 5, Eli Lilly, 2, 5; P. Fortin, None; G. Alarcón, None; J. Merrill, None; K. Kalunian, Roche, 5, Biogen, 5, Janssen, 5, AstraZeneca, 5, Lupus Research Alliance, 2, Pfizer, 2, Sanford Consortium, 2, Eli Lilly, 5, Genetech, 5, Gilead, 5, ILTOO, 5, Nektar, 5, Viela, 5, Equillium, 5, Bristol-Meyers Squibb, 5; M. Ramos-Casals, None; K. Steinsson, None; A. Zoma, None; A. Askanase, Glaxo Smith Kline, 2, Astra Zeneca, 2, Janssen, 2, Eli Lilly and Company, 2, Abbvie, 5, Mallinckrodt, 2, Regeneron, 9, Pfizer, 2, Bristol Myers Squibb, 9; M. Khamashta, None; I. Bruce, None; M. Inanc, None; S. Bernatsky, None.

To cite this abstract in AMA style:

Almeida-Brasil C, Hanly J, Urowitz M, Clarke A, Ramsey-Goldman R, Gordon C, Petri M, Ginzler E, Wallace D, Bae S, Romero-Díaz J, Dooley M, A. Peschken C, Isenberg D, Rahman A, Manzi S, Jacobsen S, Lim S, Van Vollenhoven R, Nived O, Jönsen A, Kamen D, Aranow C, Ruiz-Irastorza G, Sanchez-Guerrero J, Gladman D, Fortin P, Alarcón G, Merrill J, Kalunian K, Ramos-Casals M, Steinsson K, Zoma A, Askanase A, Khamashta M, Bruce I, Inanc M, Bernatsky S. Retinal Toxicity in a Multinational Inception Cohort of Systemic Lupus Patients on Hydroxychloroquine [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/retinal-toxicity-in-a-multinational-inception-cohort-of-systemic-lupus-patients-on-hydroxychloroquine/. Accessed .

« Back to ACR Convergence 2020

ACR Meeting Abstracts - https://acrabstracts.org/abstract/retinal-toxicity-in-a-multinational-inception-cohort-of-systemic-lupus-patients-on-hydroxychloroquine/