Rheumatologists' perspective on hydroxychloroquine guidelines
| Autor: | James P Winebrake, Leila Khalili, Julia Weiner, Yevgeniya Gartshteyn, Anca Askanase, Lisa Park |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty antirheumatic agents Immunology Cohort size Cohort Studies 03 medical and health sciences 0302 clinical medicine Internal medicine therapeutics Medicine Humans In patient Dosing skin and connective tissue diseases 030203 arthritis & rheumatology Lupus erythematosus Ophthalmologists business.industry Hydroxychloroquine General Medicine systemic medicine.disease Epidemiology and Outcomes United States Clinical Practice Retinal toxicity Cohort 030221 ophthalmology & optometry Female Rheumatologists business lupus erythematosus medicine.drug |
| Zdroj: | Lupus Science & Medicine |
| ISSN: | 2053-8790 |
| Popis: | ObjectiveHydroxychloroquine (HCQ) retinal toxicity is an ongoing concern for rheumatologists. The revised 2016 American Academy of Ophthalmology (AAO) guidelines created controversy regarding the correct dosing and evaluation of HCQ toxicity. The current study was initiated to further understand rheumatologists’ practices regarding HCQ.MethodsA questionnaire-based survey was distributed electronically to rheumatologists. We collected information on HCQ dosing, clinical decision-making processes, familiarity with the AAO 2016 guidelines, and perceived disparities between the AAO 2016 guidelines and rheumatological clinical practice.Results78 rheumatologists completed the survey (49% from USA, 90% academic practices, 82% self-identified as lupus experts). Only lupus expert (n=64) data were included in subsequent analysis. The mean cohort size was 747 (50–6571), a total cohort 45 612 patients. HCQ was prescribed to >75% of patients with SLE by 81.3% of SLE experts, with routine counselling about ophthalmic risks. The typical dose of HCQ used was 200–400 mg/day. 17% of rheumatologists use doses up to 600 mg/day, while 6.2% use up to 6.5 mg/kg/day. HCQ adherence is routinely assessed. 479 cases of HCQ retinal toxicity (1.05%) and 9 cases of HCQ-associated blindness (1.8 per 10 000 patients) were reported. 89.1% of respondents reported familiarity with the AAO guidelines. Those aware of the guidelines cited limited dosing options (54.7%), lack of supporting evidence (57.8%) and low patient adherence (43.8%) as obstacles to greater implementation of the guidelines.ConclusionThese data suggest that HCQ toxicity and blindness are rare in patients with SLE. Rheumatologists treating patients with SLE are aware of the guidelines and appreciate the importance of partnering with ophthalmologists in preventing retinal toxicity. |
| Databáze: | OpenAIRE |
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