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Sharp decline in hydroxychloroquine dosing—analysis of 17,797 initiators from 2007 to 2016

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Abstract

We aimed to assess the impact of ophthalmology weight-based hydroxychloroquine (HCQ) dosing guidelines on prescribing patterns. We examined initial HCQ prescription dosing between 2007 and 2016 and determined independent predictors for HCQ dosing above the previous (2011) recommended ≤ 6.5 mg/kg of ideal body weight (IBW)/day and the latest (2016) recommended ≤ 5.0 mg/kg of actual body weight (ABW)/day using logistic regression. Among 17,797 patients (82% female), the proportion of 400 mg prescribed daily dosing declined sharply from 80% in 2007–2011 to nearly 40% in 2014, whereas the proportions of 200- and 300-mg daily doses showed the opposite trends during the same periods. Accordingly, the risk of HCQ dosing above the guideline recommendations declined by more than 60%. While 36% of normal body mass index (BMI) individuals were classified as dosing above the IBW-based guideline, 66% would have received dosing above the latest ABW-based guideline. The risk of excess dosing was associated with female patients and dermatology prescribers (adjusted odds ratios ≥ 2 according to IBW- or ABW-based guidelines). There has been a sharp decline in HCQ dosing following ophthalmology weight-based guidelines in recent years. While this trend is likely helpful in reducing the risk of retinopathy, its potential impact on HCQ efficacy remains to be clarified.

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Funding

Dr. Jorge is supported in part by the T32 Ruth L. Kirschstein Institutional National Research Service Award from the National Institutes of Arthritis and Musculoskeletal and Skin Diseases (T32-AR-007258).

Dr. Marmor is supported in part by Research to Prevent Blindness.

Dr. Choi is supported by the National Institutes of Arthritis and Musculoskeletal and Skin Diseases (P50-AR-AR060772).

Author information

Author notes

  1. Ronald B. Melles and April M. Jorge contributed equally to this work.

Authors and Affiliations

  1. Department of Ophthalmology, Kaiser Permanente, 910 Maple Street, Redwood City, CA, 94063, USA

    Ronald B. Melles

  2. Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA, 02114, USA

    April M. Jorge, Yuqing Zhang & Hyon K. Choi

  3. Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA, 94303, USA

    Michael F. Marmor

Authors
  1. Ronald B. Melles
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  2. April M. Jorge
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  4. Yuqing Zhang
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  5. Hyon K. Choi
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Corresponding author

Correspondence to April M. Jorge.

Ethics declarations

The study was performed under KPNC Institutional Review Board approval and complied with tenets of the Declaration of Helsinki. Informed consent was waived.

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Melles, R.B., Jorge, A.M., Marmor, M.F. et al. Sharp decline in hydroxychloroquine dosing—analysis of 17,797 initiators from 2007 to 2016. Clin Rheumatol 37, 1853–1859 (2018). https://doi.org/10.1007/s10067-018-4116-0

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  • DOI: https://doi.org/10.1007/s10067-018-4116-0

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