Evaluation of toxic retinopathy caused by antimalarial medications with spectral
            domain optical coherence tomography

Cabral, Renata Tavares de Souza; Klumb, Evandro Mendes; Couto, Maria Isabel Noronha Neta; Carneiro, Sueli

doi:10.5935/0004-2749.20190002

Cited by 18 publications

(11 citation statements)

References 13 publications

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“…In the current study, the frequency of confirmed hydroxychloroquine retinopathy by using 10–12 Humphury visual field and FAF was 6.3%. This was higher than Tangtavorn et al [ 29 ] and Cabral et al [ 3 ] who found the prevalence of toxic retinopathy caused by antimalarial drugs were 3.2% and 4.15%, respectively. However, it is less than Palma Sanchez et al [ 25 ] who demonstrated in a retrospective study an overall rate of retinal toxicity (13.5%) .…”

Section: Discussioncontrasting

confidence: 55%

Frequency and risk factors for hydroxychloroquine retinopathy among patients with systemic lupus erythematosus

et al. 2021

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Background Hydroxychloroquine (HCQ) is an antimalarial drug, recently used in COVID-19 treatment. Also it is considered over many years the cornerstone in treating systemic lupus erythematosus (SLE) in adults and children. The incidence of retinal affection and retinal toxicity from hydroxychloroquine is rare, but even after the HCQ is stopped, loss of vision may not be reversible and may continue to progress. Fundus autofluorescence (FAF) is one of the screening methods recommended by AAO used for the diagnosis of hydroxychloroquine retinopathy. Our aim is to detect early HCQ-induced retinopathy among SLE patients and the risk factors for its development by using fundus autofluorescence. Results In the present study, 11.3% of the studied patients had significant visual field changes upon testing. Of those, 6.3% had abnormal fundus autofluorescence. We found a significant statistical relation between hydroxychloroquine retinopathy and the duration and cumulative dose of hydroxychloroquine therapy (p value = 0.003) and decreased best-corrected visual acuity of both eyes (p value = 0.000). There was no relationship between HCQ retinopathy detected by fundus autofluorescence and daily dose of HCQ/kg, age, sex, and SLEDAI score. Conclusion Frequency of SLE patients who had confirmed HCQ-induced retinopathy was 6.3%. Hydroxychloroquine could be safely used in all SLE patients regardless of age, sex, and SLE activity. Routine ophthalmological assessment is recommended for SLE patients who received HCQ especially for those who received HCQ longer than 7 years. Fundus autofluorescence is a modern objective tool which is specific for the early detection of HCQ retinopathy.

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Section: Discussioncontrasting

confidence: 55%

Frequency and risk factors for hydroxychloroquine retinopathy among patients with systemic lupus erythematosus

et al. 2021

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“…Among the drugs currently tested in vitro and in vivo, remdesivir, ribavirin, chloroquine (CQ) and hydroxychloroquine (HCQ) have shown promising clinical results in inhibiting the viral replication of SARS-CoV-2 (Zhang et al 2020). However, while the molecular mechanisms underlying therapeutic actions and clinical benefits remain to still be explored, the search for information regarding CQ and HCQ toxicity is a priority, since it can directly contribute to the design of randomized clinical trials (Cabral et al 2019;Jorge et al 2018;Liu et al 2020;Stokkermans and Trichonas 2019;Yam and Kwok 2006;Zhang et al 2015).…”

Section: Introductionmentioning

confidence: 99%

Challenges and cares to promote rational use of chloroquine and hydroxychloroquine in the management of coronavirus disease 2019 (COVID-19) pandemic: a timely review

Pereira

2020

Journal of Toxicology and Environmental Health, Part B

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As a result of the 2019 coronavirus disease pandemic , there has been an urgent worldwide demand for treatments. Due to factors such as history of prescription for other infectious diseases, availability, and relatively low cost, the use of chloroquine (CQ) and hydroxychloroquine (HCQ) has been tested in vivo and in vitro for the ability to inhibit the causative virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, even though investigators noted the therapeutic potential of these drugs, it is important to consider the toxicological risks and necessary care for rational use of CQ and HCQ. This study provides information on the main toxicological and epidemiological aspects to be considered for prophylaxis or treatment of COVID-19 using CQ but mainly HCQ, which is a less toxic derivative than CQ, and was shown to produce better results in inhibiting proliferation of SARS-CoV-2 based upon preliminary tests.

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“…Side effects. Chloroquine is used as a chemoprophylactic and therapeutic agent for malaria and amebiasis 81 , while HCQ is a less toxic metabolite of chloroquine used to treat SLE, RA, etc. 82 .…”

Section: Duration Of Hospital Stay Of Hcq ± Azm Versus Standard Carementioning

confidence: 99%

A systematic review and meta-analysis on chloroquine and hydroxychloroquine as monotherapy or combined with azithromycin in COVID-19 treatment

Ghazy

Almaghraby

Shaaban

et al. 2020

Sci Rep

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Many recent studies have investigated the role of either Chloroquine (CQ) or Hydroxychloroquine (HCQ) alone or in combination with azithromycin (AZM) in the management of the emerging coronavirus. This systematic review and meta-analysis of either published or preprint observational studies or randomized control trials (RCT) aimed to assess mortality rate, duration of hospital stay, need for mechanical ventilation (MV), virologic cure rate (VQR), time to a negative viral polymerase chain reaction (PCR), radiological progression, experiencing drug side effects, and clinical worsening. A search of the online database through June 2020 was performed and examined the reference lists of pertinent articles for in-vivo studies only. Pooled relative risks (RRs), standard mean differences of 95% confidence intervals (CIs) were calculated with the random-effects model. Mortality was not different between the standard care (SC) and HCQ groups (RR = 0.99, 95% CI 0.61–1.59, I2 = 82%), meta-regression analysis proved that mortality was significantly different across the studies from different countries. However, mortality among the HCQ + AZM was significantly higher than among the SC (RR = 1.8, 95% CI 1.19–2.27, I2 = 70%). The duration of hospital stay in days was shorter in the SC in comparison with the HCQ group (standard mean difference = 0.57, 95% CI 0.20–0.94, I2 = 92%), or the HCQ + AZM (standard mean difference = 0.77, 95% CI 0.46–1.08, I2 = 81). Overall VQR, and that at days 4, 10, and 14 among patients exposed to HCQ did not differ significantly from the SC [(RR = 0.92, 95% CI 0.69–1.23, I2 = 67%), (RR = 1.11, 95% CI 0.26–4.69, I2 = 85%), (RR = 1.21, 95% CI 0.70–2.01, I2 = 95%), and (RR = 0.98, 95% CI 0.76–1.27, I2 = 85% )] respectively. Exposure to HCQ + AZM did not improve the VQR as well (RR = 3.23, 95% CI 0.70–14.97, I2 = 58%). The need for MV was not significantly different between the SC and HCQ (RR = 1.5, 95% CI 0.78–2.89, I2 = 81%), or HCQ + AZM (RR = 1.27, 95% CI 0.7–2.13, I2 = 88%). Side effects were more reported in the HCQ group than in the SC (RR = 3.14, 95% CI 1.58–6.24, I2 = 0). Radiological improvement and clinical worsening were not statistically different between HCQ and SC [(RR = 1.11, 95% CI 0.74–1.65, I2 = 45%) and (RR = 1.28, 95% CI 0.33–4.99), I2 = 54%] respectively. Despite the scarcity of published data of good quality, the effectiveness and safety of either HCQ alone or in combination with AZM in treating COVID-19 cannot be assured. Future high-quality RCTs need to be carried out.PROSPERO registration: CRD42020192084.

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Evaluation of toxic retinopathy caused by antimalarial medications with spectral domain optical coherence tomography

Cited by 18 publications

References 13 publications

Frequency and risk factors for hydroxychloroquine retinopathy among patients with systemic lupus erythematosus

Frequency and risk factors for hydroxychloroquine retinopathy among patients with systemic lupus erythematosus

Challenges and cares to promote rational use of chloroquine and hydroxychloroquine in the management of coronavirus disease 2019 (COVID-19) pandemic: a timely review

A systematic review and meta-analysis on chloroquine and hydroxychloroquine as monotherapy or combined with azithromycin in COVID-19 treatment

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