ShutterDivision / shutterstock.com
CHICAGO—As good an option as hydroxychloroquine (HCQ) is for many patients with rheumatic diseases, such as rheumatoid arthritis and especially lupus, safety must be an important consideration, an expert said at this April’s ACR State-of-the-Art Clinical Symposium.
The use of the antimalarial has become a controversial subject, with clinicians trying to balance the drug’s disease-modifying effects with concerns about toxicity to the retina that can impair vision in patients on high and long-term doses. Some rheumatologists worry recommendations issued in 2016 by the American Academy of Ophthalmology (AAO) call for too much caution, possibly at the expense of treatment efficacy.
James Rosenbaum, MD, wears both hats: He’s chair of arthritis and rheumatic diseases at Oregon Health & Science University, and chief of ophthalmology at Legacy Devers Eye Institute in Portland, Ore. In his talk, he said the safety concerns are not meant to curb use of HCQ. He held out acetaminophen as an example: It’s a great drug, but it’s also the top cause of liver toxicity in the U.S., so its use shouldn’t go unchecked.
CARLOS ANTONIO MOURA says
July 1, 2018 at 2:50 pmExcellent text and excellent discussion. I believe there may be an overvaluation of HCQ retinopathy. Obviously it has its risks, but the risk of not using HCQ implies a risk of increased use of corticosteroids, a drug that is known to correlate with several ocular conditions, much more often than reuquinol itself.
As Dr. Petri said, ´´the advantage to rheumatology is we all feel comfortable with personalizing´´, and this puts us at the forefront of the decision, not leaving us hostage to guidelines or questionable evidences that changes every sunrise.
Thanks Thomas Collins