Multifocal electroretinographic changes after cessation of plaquenil therapy for suspected toxicity
What:
Paper Presentation | Présentation d'article
When:
3:50 PM, Sunday 3 Jun 2018
(10 minutes)
Where:
How:
Authors: Beatrice Adamptey, Chris Rudnisky, Ian M. MacDonald
Author Disclosure Block: B. Adamptey: None. C. Rudnisky: None. I.M. MacDonald: None.
Abstract Body:
Purpose: To describe multifocal electroretinogram (mfERG) changes among patients suspected to show hydroxychloroquine (Plaquenil) toxicity and their outcomes after discontinuation of Plaquenil therapy.
Study Design: A retrospective case series of 14 patients followed with mfERG testing as part of a screening program for monitoring Plaquenil therapy.
Methods: Multifocal ERG charts of six hundred patients screened for Plaquenil retinopathy at the Eye Institute of Alberta, Edmonton, were reviewed. Patients with abnormal mfERG test results, defined as elevated ring 1/3 ratio above the upper limit of the 95% confidence interval of age normative range or reduced ring 1, 2, 3 amplitudes below the lower limit of the 95% confidence interval of age normative data with or without delayed implicit time, were identified. Their ERG results were correlated with spectral domain optical coherence tomography and Humphrey 10-2 automated visual field data, when data was available. Patients who discontinued therapy as a result of screening were identified; multifocal ERGs were recorded at 6 month intervals over a period of three years.
Results: Fifty patients were identified as having abnormal mfERGs: 14 of these patients discontinued therapy. Nine of the 14 patients who discontinued therapy experienced reversal of the abnormal mfERG findings (improved ring 1, 2, 3 amplitudes and ring 1/3 ratio to normative data) within six months of cessation. Progression of the abnormal mfERG findings (further reduction in ring amplitudes) was observed in four patients while one patient experienced neither progression nor reversal of the abnormal mfERG result. Patients who experienced progression of the mfERG findings had advanced disease (depressed ring amplitudes with rings 1, 2, 3 amplitudes reduced by 80% of age normative data) and delayed implicit times. Although there were no statistically significant differences (p>0.05) between the two groups in terms of their clinical characteristics such as daily drug dose per body weight, duration of therapy, cumulative drug dose and age, the mean of these characteristics was higher for patients with progression than those with reversal of abnormal findings, with a 14.3 ± 4.6 mean years of therapy, 6.3 ± 2 mg daily drug dose per kilogram, and a mean age of 65.5±3.4 years.
Conclusions: Hydroxychloroquine retinopathy, when detected before severe depression by multifocal electroretinography, may be reversed; however, the possibility of reversal is unlikely in advanced disease. Cases that experience reversal of toxicity do so within six months of cessation.
Author Disclosure Block: B. Adamptey: None. C. Rudnisky: None. I.M. MacDonald: None.
Abstract Body:
Purpose: To describe multifocal electroretinogram (mfERG) changes among patients suspected to show hydroxychloroquine (Plaquenil) toxicity and their outcomes after discontinuation of Plaquenil therapy.
Study Design: A retrospective case series of 14 patients followed with mfERG testing as part of a screening program for monitoring Plaquenil therapy.
Methods: Multifocal ERG charts of six hundred patients screened for Plaquenil retinopathy at the Eye Institute of Alberta, Edmonton, were reviewed. Patients with abnormal mfERG test results, defined as elevated ring 1/3 ratio above the upper limit of the 95% confidence interval of age normative range or reduced ring 1, 2, 3 amplitudes below the lower limit of the 95% confidence interval of age normative data with or without delayed implicit time, were identified. Their ERG results were correlated with spectral domain optical coherence tomography and Humphrey 10-2 automated visual field data, when data was available. Patients who discontinued therapy as a result of screening were identified; multifocal ERGs were recorded at 6 month intervals over a period of three years.
Results: Fifty patients were identified as having abnormal mfERGs: 14 of these patients discontinued therapy. Nine of the 14 patients who discontinued therapy experienced reversal of the abnormal mfERG findings (improved ring 1, 2, 3 amplitudes and ring 1/3 ratio to normative data) within six months of cessation. Progression of the abnormal mfERG findings (further reduction in ring amplitudes) was observed in four patients while one patient experienced neither progression nor reversal of the abnormal mfERG result. Patients who experienced progression of the mfERG findings had advanced disease (depressed ring amplitudes with rings 1, 2, 3 amplitudes reduced by 80% of age normative data) and delayed implicit times. Although there were no statistically significant differences (p>0.05) between the two groups in terms of their clinical characteristics such as daily drug dose per body weight, duration of therapy, cumulative drug dose and age, the mean of these characteristics was higher for patients with progression than those with reversal of abnormal findings, with a 14.3 ± 4.6 mean years of therapy, 6.3 ± 2 mg daily drug dose per kilogram, and a mean age of 65.5±3.4 years.
Conclusions: Hydroxychloroquine retinopathy, when detected before severe depression by multifocal electroretinography, may be reversed; however, the possibility of reversal is unlikely in advanced disease. Cases that experience reversal of toxicity do so within six months of cessation.
