Dermatologists’ Adherence to the Latest Recommendations for Screening of Hydroxychloroquine Retinopathy in Saudi Arabia: Cross-Sectional Study

Abstract

Background Hydroxychloroquine (HCQ) has been used to manage many inflammatory skin conditions. Nevertheless, retinopathy continues to be its most significant adverse effect. The American Academy of Ophthalmology (AAO) recommends baseline ophthalmologic screening in the first year of HCQ treatment. However, a recent study found an inadequate awareness of the recommendations. Furthermore, limited data are available regarding the implementation of the recommendations among dermatologists. Objective The aim of this study was to assess dermatologists’ adherence to recommendations pertaining to their current practice regarding HCQ toxicity detection. Methods A self-administrated questionnaire was distributed between February 2 and May 4, 2018, among members of the Saudi Society of Dermatology. The questionnaire comprised demographic-related questions and questions pertaining to each physician’s routine practice about the follow-up of HCQ-treated patients. Results A total of 76 dermatologists completed the questionnaire. We achieved a response rate of 62.54%. More than half (43/76, 56%) of the dermatologists were male. Furthermore, more than half (41/76, 53%) of them reported treating 1 to 3 patients with HCQ during the last year. Furthermore, two-thirds (47/76, 61%) of them reported screening patients before initiating HCQ treatment. Regarding follow-up recommendations, 59% (45/76) of dermatologists reported yearly after starting treatment for no-risk patients, whereas 94% (72/76) reported “yearly within 5 years of treatment” for at-risk patients. Data were considered significant at P<.05. All analyses were performed using SPSS, version 20 (IBM). Conclusions Dermatologists in Saudi Arabia are not well informed about some aspects of the latest recommendations regarding screening for HCQ toxicity in terms of tests, follow-up timing, cessation of the drug, and causative agents. Therefore, we recommend conducting more studies in Saudi Arabia to determine the adherence of more physicians to the AAO recommendations. Furthermore, patient education regarding HCQ toxicity and increased patient awareness are recommended for effective and safe HCQ use.

Dermatologists’ and Rheumatologists’ Adherence to the Latest Recommendations for Screening of Hydroxychloroquine Retinopathy in Saudi Arabia: A Cross-Sectional Study

“…In 2019, the adherence of Saudi Arabian dermatologists to HCQ screening recommendations for retinopathy was investigated among 76 dermatologists. Based on this research, it was found that the current standard of care for HCQ toxicity screening is lacking in several ways, including the use of the right diagnostic tests, the right amount of time between follow-ups, the prompt withdrawal of medications, and the identification of the causative agents [10]. Despite the limitations of this research regarding the sample size, no further studies were done in Saudi Arabia.…”

The Impact of Systemic Medications on Retinal Function

“…In addition, early/moderate cases oftentimes will remain stable after drug discontinuation, while severe cases may continue to advance for up to 20 years 85–88. Unfortunately, screening regimens and dosing practices remain insufficient and inconsistent despite published guidelines, emphasizing the importance of ophthalmologists and retina specialists in patient education 89–95…”

“…[85][86][87][88] Unfortunately, screening regimens and dosing practices remain insufficient and inconsistent despite published guidelines, emphasizing the importance of ophthalmologists and retina specialists in patient education. [89][90][91][92][93][94][95]…”

A Multidisciplinary Collaborative Approach to Retinal Toxic Effects Screening for Dermatology Patients Taking Antimalarials

“…In 2016, the American Academy of Ophthalmology published a statement on screening for antimalarial-induced retinopathy, authored by ophthalmologists, and the American College of Rheumatology posted a position statement on dosing of antimalarials and screening for retinopathy, authored by rheumatologists . The lack of interdisciplinary guidelines and prior studies showing nonadherence to single-specialty guidelines by dermatologists, rheumatologists, and opthalmologists highlight the important need for close collaboration between prescribing clinicians and ECSs to ensure the maximum therapeutic benefits of antimalarials while safeguarding vision. Recognizing this need, a multispecialty group of rheumatologists, ophthalmologists, and dermatologists authored a joint statement on the use of hydroxychloroquine and retinal screening and to stress the need for collaborative management .…”

“…4. Eye care specialists should recognize of the medical value of hydroxychloroquine, avoiding drug cessation in cases of uncertain or borderline findings.…”