ArticleRheumatology (Oxford, England)2020
Risk factors for hydroxychloroquine retinopathy in systemic lupus erythematosus: a case-control study with hydroxychloroquine blood-level analysis.
Article in Rheumatology (Oxford, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.
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Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it, 48 citations in OpenAlex.
- Risk of Retinopathy Associated with Long-Term Use of Hydroxychloroquine in Patients with Rheumatic Diseases: A Systematic Review and Meta-Analysis.Arthritis care & research · 2026Pooled it
- Management of systemic lupus erythematosus: a systematic literature review informing the 2023 update of the EULAR recommendations.Annals of the rheumatic diseases · 2024Pooled it
- Comparison of flares in 85 patients with SLE who maintained, discontinued or reduced dose of hydroxychloroquine during a prospective study of ophthalmological screening for retinopathy (PERFOCTAPS Study).Lupus science & medicine · 2025Trial
- Optical Coherence Tomography and Angiography in Hydroxychloroquine Retinopathy: A Narrative Review.Diagnostics (Basel, Switzerland) · 2026Review
- Hydroxychloroquine Retinopathy in Systemic Lupus Erythematosus: Risk Factors, Screening, and Emerging Biomarkers.Journal of ophthalmology · 2026Review
- Safety of Hydroxychloroquine: What a Dermatologist Should Know.American journal of clinical dermatology · 2025Review
- Refining lupus management: a comprehensive review of HCQ blood levels.Rheumatology advances in practice · 2025Review
- Target in Sight: A Comprehensive Review of Hydroxychloroquine-Induced Bull's Eye Maculopathy.Current ophthalmology reports · 2024Article
- Review
- Risk Factors for Hydroxychloroquine Retinopathy and Its Subtypes.JAMA network open · 2024Article
- Effect of hydroxychloroquine blood concentration on the efficacy and ocular toxicity of systemic lupus erythematosus.Scientific reports · 2024Article
- Reference Range of Hydroxychloroquine Blood Levels That Can Reduce Odds of Active Lupus and Prevent Flares.Arthritis care & research · 2024Article
- Treatment of lupus nephritis: consensus, evidence and perspectives.Nature reviews. Rheumatology · 2023Review
- Unmet needs and future perspectives in hydroxychloroquine retinopathy.Frontiers in medicine · 2023Article
- Retinal toxicity in a multinational inception cohort of patients with systemic lupus on hydroxychloroquine.Lupus science & medicine · 2022Article
- Hydroxychloroquine in systemic lupus erythematosus: overview of current knowledge.Therapeutic advances in musculoskeletal disease · 2022Review
- Frequency and risk factors for hydroxychloroquine retinopathy among patients with systemic lupus erythematosus.The Egyptian journal of internal medicine · 2021Article
Corrections and comments
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Authors and funding
20 authors at 11 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveHCQ is an essential medication in SLE, proven to lengthen survival and reduce flares. Its use, however, is limited by its rare but severe ophthalmological complications. Here, we aimed to analyse factors associated with HCQ retinopathy including HCQ blood levels.
methodsThis case-control study compared SLE patients with and without HCQ retinopathy, defined by abnormal results for at least two of the following ophthalmological tests: automated visual fields, spectral-domain optical coherence tomography (SD-OCT), multifocal electroretinogram (mfERG) and fundus autofluorescence. We compared clinical and laboratory findings to assess risk factors for HCQ retinopathy.
resultsThe study included 23 patients with confirmed retinopathy (cases) and 547 controls. In the univariate analysis, age (P < 0.001), height (P = 0.045), creatinine clearance (P < 0.001), haemoglobin concentration (P = 0.01), duration of HCQ intake, (P < 0.001), higher cumulative HCQ dose (P < 0.001) and geographical origin (West Indies and sub-Saharan Africa) (P = 0.007) were associated with the risk of retinopathy, while HCQ blood levels were not. In the multivariate analysis, only cumulative dose (P = 0.016), duration of intake (P = 0.039), creatinine clearance (P = 0.002) and geographical origin (P < 0.0001, odds ratio 8.7) remained significantly associated with retinopathy.
conclusionSLE patients on HCQ should be closely monitored for retinopathy, especially those from the West Indies or sub-Saharan Africa, or with renal insufficiency, longer HCQ intake or a high cumulative dose. Although reducing the daily dose of HCQ in patients with persistently high HCQ blood levels seems logical, these concentrations were not associated with retinopathy in this study with controls adherent to treatment.
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