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Rethinking the Hydroxychloroquine Dosing and Retinopathy Screening Guidelines.
Am J Ophthalmol. 2020 Jun 28 [Online ahead of print]AJ

Abstract

PURPOSE

To describe the rationale for revising the hydroxychloroquine (HCQ) dosing and screening guidelines and to identify the barriers to more effective guidelines in the future.

DESIGN

Literature review.

METHODS

A PubMed query of studies on HCQ dosing and hydroxychloroquine retinopathy (HCQR) screening was done with a selective review of the English language literature.

RESULTS

Three iterations of the American Academy of Ophthalmology HCQ dosing and HCQR screening guidelines have been published without including prescribing physicians on the writing committees. This may contribute prescribing physicians' low adherence to the guidelines. As ancillary tests have improved, asymptomatic HCQR is being detected earlier, leading to a higher reported prevalence of HCQR and a drop in the ceiling for safe dosing. These trends put stricter constraints on prescribers and their patients, who may have had well-controlled autoimmune disease on HCQ doses previously considered below the high-risk threshold for HCQR. Indeed, stopping HCQ at the earliest sign of HCQR should be reconsidered; for cases of early HCQR, dose reduction and more intensive monitoring for retinopathy may strike a more appropriate balance between HCQ risk and benefits. A prospective study using the DRCR Retina network with standardized collection of data, HCQ blood levels, centralized grading of ancillary tests, and community and academic ophthalmologists would provide a stronger evidence base for future HCQ guidelines.

CONCLUSIONS

The HCQ dosing and screening guidelines should be updated and a prospective study of HCQ dosing and HCQR should be initiated as joint efforts of ophthalmologists and prescribing physicians.

Authors+Show Affiliations

Charlotte, Eye, Ear, Nose, and Throat Associates, 6035 Fairview Rd., Charlotte, NC 28210. Electronic address: djbrowning179@gmail.com.Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo 183-8524, Japan.Office of Academic Affiliations (10X1), Office of Discovery, Education, and Affiliate Networks, U.S. Veterans Health Administration, 810 Vermont Avenue NW, Washington D.C., 20420; Division of Ophthalmology, Alpert Medical School, Brown University, Providence, RI.Rhode Island Eye Institute, 150 East Manning St., Providence, RI 02906.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32610049

Citation

Browning, David J., et al. "Rethinking the Hydroxychloroquine Dosing and Retinopathy Screening Guidelines." American Journal of Ophthalmology, 2020.
Browning DJ, Yokogawa N, Greenberg PB, et al. Rethinking the Hydroxychloroquine Dosing and Retinopathy Screening Guidelines. Am J Ophthalmol. 2020.
Browning, D. J., Yokogawa, N., Greenberg, P. B., & Perlman, E. (2020). Rethinking the Hydroxychloroquine Dosing and Retinopathy Screening Guidelines. American Journal of Ophthalmology. https://doi.org/10.1016/j.ajo.2020.06.030
Browning DJ, et al. Rethinking the Hydroxychloroquine Dosing and Retinopathy Screening Guidelines. Am J Ophthalmol. 2020 Jun 28; PubMed PMID: 32610049.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rethinking the Hydroxychloroquine Dosing and Retinopathy Screening Guidelines. AU - Browning,David J, AU - Yokogawa,Naoto, AU - Greenberg,Paul B, AU - Perlman,Elliot, Y1 - 2020/06/28/ PY - 2020/03/01/received PY - 2020/06/20/revised PY - 2020/06/21/accepted PY - 2020/7/2/entrez PY - 2020/7/2/pubmed PY - 2020/7/2/medline JF - American journal of ophthalmology JO - Am. J. Ophthalmol. N2 - PURPOSE: To describe the rationale for revising the hydroxychloroquine (HCQ) dosing and screening guidelines and to identify the barriers to more effective guidelines in the future. DESIGN: Literature review. METHODS: A PubMed query of studies on HCQ dosing and hydroxychloroquine retinopathy (HCQR) screening was done with a selective review of the English language literature. RESULTS: Three iterations of the American Academy of Ophthalmology HCQ dosing and HCQR screening guidelines have been published without including prescribing physicians on the writing committees. This may contribute prescribing physicians' low adherence to the guidelines. As ancillary tests have improved, asymptomatic HCQR is being detected earlier, leading to a higher reported prevalence of HCQR and a drop in the ceiling for safe dosing. These trends put stricter constraints on prescribers and their patients, who may have had well-controlled autoimmune disease on HCQ doses previously considered below the high-risk threshold for HCQR. Indeed, stopping HCQ at the earliest sign of HCQR should be reconsidered; for cases of early HCQR, dose reduction and more intensive monitoring for retinopathy may strike a more appropriate balance between HCQ risk and benefits. A prospective study using the DRCR Retina network with standardized collection of data, HCQ blood levels, centralized grading of ancillary tests, and community and academic ophthalmologists would provide a stronger evidence base for future HCQ guidelines. CONCLUSIONS: The HCQ dosing and screening guidelines should be updated and a prospective study of HCQ dosing and HCQR should be initiated as joint efforts of ophthalmologists and prescribing physicians. SN - 1879-1891 UR - https://www.unboundmedicine.com/medline/citation/32610049/Rethinking_the_Hydroxychloroquine_Dosing_and_Retinopathy_Screening_Guidelines L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9394(20)30326-3 DB - PRIME DP - Unbound Medicine ER -
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