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. 2018 Jul 5;20(1):133.
doi: 10.1186/s13075-018-1634-8.

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

April M Jorge  1 , Ronald B Melles  2 , Yuqing Zhang  3 , Na Lu  3 , Sharan K Rai  3 , Lucy H Young  4 , Karen H Costenbader  5 , Rosalind Ramsey-Goldman  6 , S Sam Lim  7 , John M Esdaile  8 , Ann E Clarke  9 , M B Urowitz  10 , Anca Askanase  11 , Cynthia Aranow  12 , Michelle Petri  13 , Hyon Choi  3
Affiliations

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

April M Jorge et al. Arthritis Res Ther. .

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.

Keywords: DMARDs; Epidemiology; Quality of care; Rheumatoid arthritis; Systemic lupus erythematosus.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Partners Human Research Committee, protocol number 2017P000399. Informed consent was waived.

Competing interests

AEC, UCB; MU, UCB; AA, Exagen; MP, Anthera Inc., Glaxo Smith Kline, EMD Serono, Eli Lilly and Company, Bristol Meyer Squibb, Amgen, United Rheumatology, Global Academy, Exagen, HKC, Selecta, Horizon, AstraZeneca. The other authors have declared no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Trends of incident hydroxychloroquine prescription dose per ideal body weight and actual body weight (2007–2016). Median and inter-quartile ranges of incident hydroxychloroquine prescription dose, calculated per mg/kg of ideal body weight and per mg/kg of actual body weight, in relation to published guideline-recommendations
Fig. 2
Fig. 2
Incident hydroxychloroquine prescription dose trends. Proportion of incident hydroxychloroquine prescriptions in each dosing category over time, between 2007 and 2016
See this image and copyright information in PMC

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