Screening for hydroxychloroquine retinopathy

BMJ 1998;317:1388 ( 14 November )

Letters

Screening for hydroxychloroquine retinopathy

Screening should be selective

Authors' reply

Screening should be selective

The first 150 words of the full text of this article appear below.

EDITOR $---$ The editorial on screening for hydroxychloroquine retinopathy covered none of the recent publications on the subjectand failed to distinguish those cases in which screening is necessary.¹

Levy et al's review of 1505 patients found no cases of proved retinopathy in patients taking <6.5 mg/kg/day of hydroxychloroquinebut one case in a patient taking a higher dose.² Silman andShipley point out that "bull's eye retinopathy" can occur in patientsnot taking hydroxychloroquine.³ Indeed, Scherbel et al reportedthat the incidence of maculopathy in patients with rheumatoidarthritis was greater in untreated patients than in those receivinghydroxychloroquine or chloroquine.⁴ Mavrikakis and colleagues'study of 360 patients identified two cases of retinopathy withdaily doses <6.5 mg/kg.⁵ In both of these cases the cumulativedose exceeded 700g.

Research confirms that hydroxychloroquine is safer than chloroquine and that at a daily dose of hydroxychloroquine <6.5mg/kgthe risk of retinopathy is negligible . . . [Full text of this article]