ABSTRACT
Background/Aims Hydroxychloroquine (HCQ) is used to treat rheumatoid arthritis (RA) and other inflammatory arthritides. In 2018, the Royal College of Ophthalmologists (RCOphth) published new guidelines to monitor the risk of HCQ associated retinopathy. Risk factors for retinopathy were: dosage >5mg/kg/day, impaired renal function (eGFR <60ml/min/ 1.73m2) and concurrent tamoxifen use. This report aims to audit 1) HCQ dosing based on RCOphth 2018 guidelines 2) whether patients were appropriately referred for screening 3) outcome of screening. Methods All patients (n=207) who newly started HCQ between April 2013 and November 2014 were identified from hospital outpatient pharmacy records and followed until they reached 5 years' of follow-up or 30 Nov 2019, whichever came first (censor date). Patients who were still on HCQ by the censor date were reviewed to extract data on demographics, rheumatological diagnosis, starting HCQ dose and risk factors, and were subsequently referred for retinopathy screening via a referral proforma. Exclusions were those who stopped HCQ, prescribed HCQ for non-rheumatological conditions, transferred to a different trust, duplicate or deceased patients. Screening took place between 1 Nov 2018 until 30 June 2019, after which referrals were paused due to lack of capacity and finally stopped due to COVID-19. Results 86 patients were identified and eligible for screening (study cohort) (Table). The median age of the cohort was 57 years, with 67% of the cohort being female. 23% of patients were prescribed a dose of>5mg/kg/day. 10% of patients had an eGFR of<60 ml/min/ 1.73m2. No patients were on tamoxifen. Conclusion After 5 years of follow-up, the drug survival for HCQ is just under half the number (43%) who started the drug. This will help plan screening service capacity issues. The department is investigating the 'lost referrals' which seem disproportionately high, which could be due to IT issues or occurred when the screening service was paused. Of the 29 patients who attended for screening, none had evidence of HCQ retinopathy which is reassuring, these included 15 patients with risk factors for retinopathy. (Table Presented).