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Antimalarials can cause retinal toxicity in patients with rheumatic diseases
Patients with rheumatic diseases who received long-term antimalarial drug treatments discontinued their use more than half the time because of adverse events, including ophthalmologic toxicity, according to study results.
In a retrospective study of 778 patients with autoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), researchers in Madrid, Spain, reviewed clinical records from January 1990 to July 2007. The study included patients who received antimalarial (AM) prescriptions for chloroquine (CQ) or hydroxychloroquine (HCQ).
Among 869 courses of treatment, 204 were discontinued (95% CI, 186-224). Investigators found that 52% of the discontinued AM treatments were stopped due to adverse events after a median of 3.33 years of use, 14% for lack of efficacy and 34% for other reasons, including patient refusal to take medications, pregnancy, ocular comorbidity and disease remission. Among the adverse events, 54.5% of patients discontinued AM use because of gastrointestinal, neuro-psychiatric or skin conditions. The remaining 45.5% of adverse reactions were related to ophthalmologic events.
Antimalarial retinopathy occurred in nine patients (incidence rate [IR]=3.97 per 1,000 patient-years; 95% CI, 2.06-7.62), with one of them suffering irreversible loss of vision (IR=0.44; 95% CI, 0.06-3.12). Female sex (HR=1.43; 95% CI, 1.09-1.87), increased age (HR=1.02; 95% CI, 1.01-1.03), use of CQ and HCQ (HR=1.65; 95% CI, 1.01-2.70) and a diagnosis of SLE vs. RA (HR=0.58; 95% CI, 0.44-0.77) increased the risk for discontinuing AM treatments because of ophthalmologic adverse events.
“Our results suggest that AM [drugs] have a good safety profile,” researchers said. “[However,] … the potential for an unusual but serious ophthalmolgoic toxicity emphasizes the importance of close ophthalmologic monitoring … [and] stresses the need for a more individualized monitoring system to predict and detect early AM-related retinal toxicity, in order to increase the safety and quality of care of AM patients.”