Hydroxychloroquine-induced retinopathy in Puerto Ricans with systemic lupus erythematosus: Associated factors and early-onset risk

Abstract

Objective

To determine factors associated with hydroxychloroquine (HCQ)-induced retinopathy in Puerto Ricans with systemic lupus erythematosus (SLE) and to evaluate determinants of early HCQ-induced retinopathy.

Methods

We conducted a retrospective study of adult Puerto Ricans with SLE. Patients with ophthalmologist-confirmed HCQ-induced retinopathy were compared with those without retinopathy. A subgroup analysis comparing patients with early-onset (≤5 years) versus late-onset (>5 years) retinopathy was also performed. Demographic factors, clinical manifestations, and pharmacologic treatments were analyzed using bivariate methods and logistic regression models adjusted for SLE duration.

Results

A total of 279 patients were included; 41 had HCQ-induced retinopathy, while 238 did not. Among patients with HCQ-induced retinopathy, the mean age (SD) was 45.2 (13.2) years, and 90.2% were women. The mean (SD) SLE duration and HCQ treatment duration were 10.3 (7.7) years and 9.1 (5.8) years, respectively. Patients with HCQ-induced retinopathy were more likely to have higher daily and weight-adjusted HCQ doses and greater damage accrual, but were less likely to have proteinuria, lymphopenia, anti-dsDNA positivity, low complement levels or exposure to mycophenolate mofetil. Among patients with HCQ-induced retinopathy, 13 (31.7%) discontinued HCQ within 5 years of treatment initiation. In multivariable analysis, early-onset toxicity was associated with corticosteroid exposure.

Conclusions

In this cohort of Puerto Rican Hispanics with SLE, HCQ-induced retinopathy occurred in 14.7% of patients, and nearly 32% of those affected developed early-onset retinopathy. Retinopathy was primarily associated with higher daily and weight-adjusted HCQ doses, while early-onset retinopathy was associated with corticosteroid exposure. These findings provide population-specific data that may help optimize HCQ dosing and underscore the importance of regular ophthalmologic screening, even during the early years of therapy.