Evidence map›Paper›PMID 29976231›Full record

ArticleArthritis research & therapy2018

Hydroxychloroquine prescription trends and predictors for excess dosing per recent ophthalmology guidelines.

April M Jorge, Ronald B Melles, Yuqing Zhang, Na Lu, Sharan K Rai, Lucy H Young, Karen H Costenbader, Rosalind Ramsey-Goldman, S Sam Lim, John M Esdaile and 6 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Arthritis research & therapy, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

15 citing papers in PubMed.

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  11. Guide for Nuclear Medicine Applications During the COVID-19 Outbreak.Molecular imaging and radionuclide therapy · 2020
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

April M JorgeDivision of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA, 02114, USA. AMJorge@mgh.harvard.edu.ORCID 0000-0001-6935-880X
Ronald B MellesDepartment of Ophthalmology, Kaiser Permanente, Redwood City, CA, USA.
Yuqing ZhangDivision of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA, 02114, USA.
Na LuDivision of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA, 02114, USA.
Sharan K RaiDivision of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA, 02114, USA.
Lucy H YoungDepartment of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
Karen H CostenbaderDivision of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Rosalind Ramsey-GoldmanRheumatology Division, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
S Sam LimDivision of Rheumatology, Emory University School of Medicine, Atlanta, GA, USA.
John M EsdaileArthritis Research Canada, Richmond, BC, Canada.
Ann E ClarkeDivision of Rheumatology, University of Calgary, Calgary, AB, Canada.
M B UrowitzCentre for Prognosis Studies in the Rheumatic Diseases, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada.
Anca AskanaseRheumatology, Columbia University College of Physicians & Surgeons, New York, NY, USA.
Cynthia AranowAutoimmune and Musculoskeletal Disease, The Feinstein Institute for Medical Research, Manhasset, NY, USA.
Michelle PetriDivision of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Hyon ChoiDivision of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA, 02114, USA.

Funding

Harvard Clinical and Translational Science CenterUL1TR001102 · NCATS · HARVARD MEDICAL SCHOOL · PI NADLER, LEE MARSHALL · 2013 to 2017
$106.2M
WORK DISABILITY-- PERSONS WITH RHEUMATOID ARTHRITISP60AR047785 · NIAMS · BOSTON UNIVERSITY MEDICAL CAMPUS · PI ZHANG, YUQING · 2001 to 2016
$18.0M
Research Training in Rheumatology at Massachusetts General HospitalT32AR007258 · NIAMS · MASSACHUSETTS GENERAL HOSPITAL · PI ANDREW D LUSTER · 1986 to 2026
$6.9M
Cardiovascular Disease Epidemiology in Patients with LupusK24AR066109 · NIAMS · BRIGHAM AND WOMEN'S HOSPITAL · PI COSTENBADER, KAREN H · 2014 to 2023
$1.7M
NCATS NIH HHS UL1 TR001102NIAMS NIH HHS K24 AR066109NIAMS NIH HHS P60 AR047785NIAMS NIH HHS T32 AR007258
6 · The paper itself

Abstract

backgroundHydroxychloroquine (HCQ) retinopathy may be more common than previously recognized; recent ophthalmology guidelines have revised recommendations from ideal body weight (IBW)-based dosing to actual body weight (ABW)-based dosing. However, contemporary HCQ prescribing trends in the UK remain unknown.

methodsWe examined a UK general population database to investigate HCQ dosing between 2007 and 2016. We studied trends of excess HCQ dosing per ophthalmology guidelines (defined by exceeding 6.5 mg/kg of IBW and 5.0 mg/kg of ABW) and determined their independent predictors using multivariable logistic regression analyses.

resultsAmong 20,933 new HCQ users (78% female), the proportions of initial HCQ excess dosing declined from 40% to 36% using IBW and 38% to 30% using ABW, between 2007 and 2016. Among these, 47% of women were excess-dosed (multivariable OR 12.52; 95% CI 10.99-14.26) using IBW and 38% (multivariable OR 1.98; 95% CI,1.81-2.15) using ABW. Applying IBW, 37% of normal and 44% of obese patients were excess-dosed; however, applying ABW, 53% of normal and 10% of obese patients were excess-dosed (multivariable ORs = 1.61 and 0.1 (reference = normal); both p < 0.01). Long-term HCQ users showed similar excess dosing.

conclusionA substantial proportion of HCQ users in the UK, particularly women, may have excess HCQ dosing per the previous or recent weight-based guidelines despite a modest decline in recent years. Over half of normal-BMI individuals were excess-dosed per the latest guidelines. This implies the potential need to reduce dosing for many patients but also calls for further research to establish unifying evidence-based safe and effective dosing strategies.

Indexed as

AdultAgedAntirheumatic AgentsBody Mass IndexBody WeightDrug Dosage CalculationsFemaleHumansHydroxychloroquineLogistic ModelsLupus Erythematosus, SystemicMaleMiddle AgedOphthalmologyPractice Guidelines as TopicPrognosisAntirheumatic AgentsHydroxychloroquineDMARDsEpidemiologyQuality of careRheumatoid arthritisSystemic lupus erythematosus

Identifiers

PMID29976231
PMCPMC6034317

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.