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Risk Factors for Hydroxychloroquine Retinopathy

A long-term hydroxychloroquine users study found that 2.7% developed retinopathy, and identified risk factors as  increasing age, female sex, chronic kidney disease stage 3+ and tamoxifen use.

This Kaiser Permanente cohort study of 4677 patients initiating hydroxychloroquine, and underwent retinopathy screening after 5 years, with up to 15 years of follow-up. Incident hydroxychloroquine retinopathy was classified as parafoveal or pericentral pattern. 

The mean age at initiation, 52 years; and 83% were women. A total of 125 patients (2.7%) developed hydroxychloroquine retinopathy within 15 years (102 parafoveal, 23 pericentral). 

Significant high risk attributes included: 

  • Older age (HR 2.48 for those aged 45 to 54 years; HR 3.82 for 55 to 64 years, and HR 5.68 for 65 years or older 
  • Females (HR, 3.83)
  • CKD stage 3 or greater (HR 1.95)
  • Tamoxifen use (HR 3.43)
  • Asian patients (HR 15.02) and Black patients (HR 5.51) compared with non-Hispanic White patients.

These factors should be incorporated into hydroxychloroquine dosing decisions.


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The author has no conflicts of interest to disclose related to this subject