Title |
Hydroxychloroquine prescription trends and predictors for excess dosing per recent ophthalmology guidelines
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Published in |
Arthritis Research & Therapy, July 2018
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DOI | 10.1186/s13075-018-1634-8 |
Pubmed ID | |
Authors |
April M. Jorge, Ronald B. Melles, Yuqing Zhang, Na Lu, Sharan K. Rai, Lucy H. Young, Karen H. Costenbader, Rosalind Ramsey-Goldman, S. Sam Lim, John M. Esdaile, Ann E. Clarke, M. B. Urowitz, Anca Askanase, Cynthia Aranow, Michelle Petri, Hyon Choi |
Abstract |
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. 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. 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. 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. |
X Demographics
Geographical breakdown
Country | Count | As % |
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Spain | 1 | 25% |
United Kingdom | 1 | 25% |
Unknown | 2 | 50% |
Demographic breakdown
Type | Count | As % |
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Members of the public | 4 | 100% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 74 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Other | 11 | 15% |
Student > Master | 8 | 11% |
Researcher | 7 | 9% |
Professor | 5 | 7% |
Student > Ph. D. Student | 5 | 7% |
Other | 15 | 20% |
Unknown | 23 | 31% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 25 | 34% |
Pharmacology, Toxicology and Pharmaceutical Science | 4 | 5% |
Biochemistry, Genetics and Molecular Biology | 4 | 5% |
Nursing and Health Professions | 3 | 4% |
Immunology and Microbiology | 3 | 4% |
Other | 6 | 8% |
Unknown | 29 | 39% |