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

• Type of Material: Article
• Authors: April M. Jorge, Harvard Medical School; Ronald B. Melles, Kaiser Permanente; Yuqing Zhang, Harvard Medical School; Na Lu, Harvard Medical School; Sharan K. Rai, Harvard Medical School; Lucy H. Young, Harvard Medical School; Karen H. Costenbader, Harvard Medical School; Rosalind Ramsey-Goldman, Northwestern University; S Sam Lim, Emory University; John M. Esdaile, Arthritis Research Canada; Ann E. Clarke, University of Calgary; M.B. Urowitz, University of Toronto; Anca Askanase, Columbia University College of Physicians & Surgeons; Cynthia Aranow, The Feinstein Institute for Medical Research; Michelle Petri, Johns Hopkins University; Hyon Choi, Harvard Medical School
• Language: English
• Date: 2018-07-05
• Publisher: BMC (part of Springer Nature)
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s13075-018-1634-8
• Title of Journal or Parent Work: Arthritis Research and Therapy
• ISSN: 1478-6354
• Volume: 20
• Issue: 1
• Start Page: 133
• End Page: 133
• Grant/Funding Information: This project was supported in part by the Ruth L. Kirschstein Institutional National Research Service Award T32-AR-007258, National Institutes of Health NIH Grant P60-AR-047785.
• Keywords: RECOMMENDATIONS; Epidemiology; Rheumatology; RETINAL TOXICITY; CHLOROQUINE; Rheumatoid arthritis; SYSTEMIC-LUPUS-ERYTHEMATOSUS; DMARDs; Systemic lupus erythematosus; RHEUMATOID-ARTHRITIS; RETINOPATHY; SURVIVAL; THERAPY; Science & Technology; Life Sciences & Biomedicine; Quality of care
• Research Categories: Health Sciences, Opthamology; Health Sciences, Immunology

Abstract

Background: Hydroxychloroquine (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. Methods: We 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. Results: Among 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. Conclusion: A 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.