Rapid Onset of Retinal Toxicity From High-Dose Hydroxychloroquine Given for Cancer Therapy

Leung, Loh-Shan B.; Neal, Joel W.; Wakelee, Heather A.; Sequist, Lecia V.; Marmor, Michael F.

doi:10.1016/j.ajo.2015.07.012

Cited by 76 publications

(66 citation statements)

References 12 publications

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“…Rapid onset toxic retinopathy has been reported in two out of seven patients being treated with erlotinib and high dose HCQ (1000 mg daily) for nonsmall cell lung cancer. 50 The affected patients developed HCQ retinopathy at 11 and 17 months of exposure and were detected by screening in the pre-symptomatic stage of disease. 50 In a series of 12 patients who underwent HCQ therapy (800 mg/day) for chronic Graft versus Host disease, three developed retinal toxicity with scotomata on Amsler's grid, central visual field testing (10-2) and mfERG.…”

Section: Tamoxifenmentioning

confidence: 99%

Hydroxychloroquine retinopathy

Yusuf

Sharma

Luqmani

et al. 2017

Eye

215

189

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Hydroxychloroquine (HCQ; Plaquenil) is used increasingly in the management of a variety of autoimmune disorders, with well established roles in dermatology and rheumatology and emerging roles in oncology. Hydroxychloroquine has demonstrated a survival benefit in patients with systemic lupus erythematosus; some clinicians advocate its use in all such patients. However, Hydroxychloroquine and chloroquine (CQ) have been associated with irreversible visual loss due to retinal toxicity. Hydroxychloroquine retinal toxicity is far more common than previously considered; an overall prevalence of 7.5% was identified in patients taking HCQ for greater than 5 years, rising to almost 20% after 20 years of treatment. This review aims to provide an update on HCQ/CQ retinopathy. We summarise emerging treatment indications and evidence of efficacy in systemic disease, risk factors for retinopathy, prevalence among HCQ users, diagnostic tests, and management of HCQ retinopathy. We highlight emerging risk factors such as tamoxifen use, and new guidance on safe dosing, reversing the previous recommendation to use ideal body weight, rather than actual body weight. We summarise uncertainties and the recommendations made by existing HCQ screening programmes. Asian patients with HCQ retinopathy may demonstrate an extramacular or pericentral pattern of disease; visual field testing and retinal imaging should include a wider field for screening in this group. HCQ is generally safe and effective for the treatment of systemic disease but because of the risk of HCQ retinal toxicity, modern screening methods and ideal dosing should be implemented. Guidelines regarding optimal dosing and screening regarding HCQ need to be more widely disseminated.

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Section: Tamoxifenmentioning

confidence: 99%

Hydroxychloroquine retinopathy

Yusuf

Sharma

Luqmani

et al. 2017

Eye

215

189

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“…The sensitivities of mfERG, 10-2 VF and SD-OCT in detecting CQ/HCQ retinopathy were 92.9, 85.7 and 78.6%, respectively, and the specificities of mfERG, 10-2 VF and SD-OCT were 86.9, 92.5 and 98.1%, respectively. mfERG demonstrates most commonly a paracentral ring depression of signals around the fovea [24,25,27,28,36]. Kellner et al [6] compared mfERG responses to FAF findings and showed that only 8 of 13 patients under CQ/HCQ therapy with abnormal mfERG responses had FAF abnormalities.…”

Section: Cq and Hcq Retinopathymentioning

confidence: 99%

“…All affected patients had been taking HCQ for at least 7 years. Recently, Leung et al [36] found that high doses of HCQ can lead to retinal toxicity within 1-2 years. Widespread signal depression across the macula and especially in the parafoveal region was observed with mfERG in 2 of 7 patients studied.…”

Section: Cq and Hcq Retinopathymentioning

confidence: 99%

“…Widespread signal depression across the macula and especially in the parafoveal region was observed with mfERG in 2 of 7 patients studied. Therefore, it is suggested that patients who take HCQ at doses higher than the recommended dose (>6.5 mg/kg per day) or for a long duration (>5 years) should be considered for periodic mfERG testing for the early detection of HCQ toxicity [24,38]. Moschos et al [39] demonstrated that mfERG amplitudes were markedly improved 6 months after HCQ cessation for both central and peripheral responses (fig.…”

Section: Cq and Hcq Retinopathymentioning

confidence: 99%

See 1 more Smart Citation

The Role of Multifocal Electroretinography in the Assessment of Drug-Induced Retinopathy: A Review of the Literature

Dettoraki

Moschos²

2016

Ophthalmic Res

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Multifocal electroretinography (mfERG) is an objective, noninvasive examination for the assessment of visual function. It enables the stimulation of multiple retinal areas simultaneously and recording of each response independently, providing a topographic measure of retinal electrophysiological activity in the central 40-50° of the retina. A clinical application of mfERG represents the assessment of retinal toxicity associated with systemic medications. Drug-induced retinopathy represents a disease that, although not common, requires early recognition: if not detected early, it may progress and cause irreversible retinal dysfunction with subsequent visual impairment. This review aims to evaluate the use of mfERG in the assessment of retinal dysfunction associated with various systemic pharmacological agents based on the currently available literature. The most commonly recognized systemic medications affecting retinal function are included, such as chloroquine and hydroxychloroquine, vigabatrin, deferoxamine, ethambutol, interferon-α, tamoxifen, digoxin, sildenafil, canthaxanthin, amiodarone and nefazodone. The role of mfERG in the early diagnosis of retinal toxicity and the evaluation of disease severity is reviewed, as well as its clinical value in monitoring disease progression or recovery after drug cessation.

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“…causes central nervous system toxicity of retinopathy and epilepsy up to 25 to 40 % in rheumatoid arthritis patients at 20 mg/kg dosage for prolonged period [16][17][18] and nanoparticles may reduce the same. Current work is to biosynthesis and characterization of the chloroquine silver nanoparticles (CQ AgNPs) and tested anticancer activity against Neuroblastoma (SH-SY5Yc) and cytotoxicity was also investigated against normal Vero cells by MTT assay.…”

mentioning

confidence: 99%