Hydroxychloroquine prescription trends and predictors for excess dosing per recent ophthalmology guidelines

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dc.contributor.authorJorge, April M
dc.contributor.authorMelles, Ronald B
dc.contributor.authorZhang, Yuqing
dc.contributor.authorLu, Na
dc.contributor.authorRai, Sharan K
dc.contributor.authorYoung, Lucy H
dc.contributor.authorCostenbader, Karen H
dc.contributor.authorRamsey-Goldman, Rosalind
dc.contributor.authorLim, S. Sam
dc.contributor.authorEsdaile, John M
dc.contributor.authorClarke, Ann E
dc.contributor.authorUrowitz, M. B
dc.contributor.authorAskanase, Anca
dc.contributor.authorAranow, Cynthia
dc.contributor.authorPetri, Michelle
dc.contributor.authorChoi, Hyon
dc.date.accessioned2018-11-07T17:04:41Z
dc.date.available2018-11-07T17:04:41Z
dc.date.issued2018-07-05
dc.date.updated2018-11-07T17:04:41Z
dc.description.abstractAbstract Background Hydroxychloroquine (HCQ) retinopathy may be more common than previously recognized; recent ophthalmology guidelines have revised recommendations from ideal body weight (IBW)-based dosing to actual body weight (ABW)-based dosing. However, contemporary HCQ prescribing trends in the UK remain unknown. Methods We examined a UK general population database to investigate HCQ dosing between 2007 and 2016. We studied trends of excess HCQ dosing per ophthalmology guidelines (defined by exceeding 6.5 mg/kg of IBW and 5.0 mg/kg of ABW) and determined their independent predictors using multivariable logistic regression analyses. Results Among 20,933 new HCQ users (78% female), the proportions of initial HCQ excess dosing declined from 40% to 36% using IBW and 38% to 30% using ABW, between 2007 and 2016. Among these, 47% of women were excess-dosed (multivariable OR 12.52; 95% CI 10.99–14.26) using IBW and 38% (multivariable OR 1.98; 95% CI,1.81–2.15) using ABW. Applying IBW, 37% of normal and 44% of obese patients were excess-dosed; however, applying ABW, 53% of normal and 10% of obese patients were excess-dosed (multivariable ORs = 1.61 and 0.1 (reference = normal); both p < 0.01). Long-term HCQ users showed similar excess dosing. Conclusion A substantial proportion of HCQ users in the UK, particularly women, may have excess HCQ dosing per the previous or recent weight-based guidelines despite a modest decline in recent years. Over half of normal-BMI individuals were excess-dosed per the latest guidelines. This implies the potential need to reduce dosing for many patients but also calls for further research to establish unifying evidence-based safe and effective dosing strategies.
dc.identifier.citationArthritis Research & Therapy. 2018 Jul 05;20(1):133
dc.identifier.doihttps://doi.org/10.1186/s13075-018-1634-8
dc.identifier.urihttp://hdl.handle.net/1880/109034
dc.language.rfc3066en
dc.rights.holderThe Author(s).
dc.titleHydroxychloroquine prescription trends and predictors for excess dosing per recent ophthalmology guidelines
dc.typeJournal Article
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