Hydroxychloroquine retinopathy, a vision-threatening condition, can be a complication of long-term hydroxychloroquine use. New research sheds light on who may be most at risk.

The study, published in JAMA Network Open and led by researchers from Massachusetts General Hospital and Kaiser Permanente Northern California, provided insights into which patients may be at higher risk and require closer monitoring.

Hydroxychloroquine is a commonly prescribed medication for the treatment of rheumatic diseases such as systemic lupus erythematosus and rheumatoid arthritis, as well as certain dermatologic conditions. While generally considered safe, the major adverse effect associated with long-term hydroxychloroquine use is retinopathy, which can lead to vision loss if not detected and treated early.

The researchers analyzed data from 4,677 patients who had taken hydroxychloroquine for at least 5 years and underwent regular retinopathy screening. They found that in addition to higher daily dose and longer duration of use, which are established risk factors, several other patient characteristics were independently associated with an increased risk of developing retinopathy.

Key findings from the study included:

• Older age at initiation of hydroxychloroquine therapy was strongly associated with higher risk, with those aged ≥ 65 years having a nearly 6-fold higher risk compared to those aged < 45 years.
• Females had an almost 4-fold higher risk of retinopathy compared to males.
• Patients with chronic kidney disease stage 3 or greater had nearly double the risk.
• Tamoxifen use was associated with over 3 times higher risk, though this finding was based on a small number of cases.
• Asian and Black patients were more likely to develop a pericentral pattern of retinopathy compared to White patients.

The study findings indicate the necessity of regular retinopathy screening for all patients on long-term hydroxychloroquine therapy, with some patients potentially needing closer monitoring. The awareness of the pericentral pattern of retinopathy, which can be missed with standard screening, was also noted.

Although this study is the largest to date to evaluate risk factors for incident hydroxychloroquine retinopathy, the authors acknowledged limitations, such as the small number of pericentral cases. Further research is needed to understand the mechanisms behind these risk associations and their clinical implications. The study provided information that may assist in guiding the use of hydroxychloroquine for patients requiring long-term treatment.

Full conflict of interest disclosures found in study.