Association of Antiretinal Antibodies with Hydroxychloroquine Toxicity in SLE
Abstract
Hydroxychloroquine (HCQ) is an important treatment for SLE patients because of its ability to reduce flares and prevent accumulation of damage. Recent studies, however, have suggested the risk of HCQ-related retinal toxicity may be higher than previously recognized. Unfortunately, there are currently no methods available to clinicians to identify patients at highest risk for HCQ toxicity. Autoantibodies (AAbs) against multiple retinal proteins have been associated with vision disturbance in both paraneoplastic and non-paraneoplastic autoimmune retinopathies (AR). Given the AAb-producing nature of SLE, it is reasonable to consider that AAbs against retinal antigens may also play a role in SLE retinopathy. In addition, AR and HCQrelated toxicity share many similarities on imaging, raising the possibility that some retinopathy attributed to HCQ could be autoimmune in nature. Our group has preliminary data indicating that 20/22 subjects with a diagnosis of HCQ-induced retinal toxicity had antiretinal antibodies (91 percent), compared to 2/6 with normal retinal testing. 83 percent of these subjects had antibodies to 3 or more retinal antigens. Based on this preliminary data, we hypothesize that anti-retinal antibodies may be a biomarker for retinal toxicity in SLE patients taking HCQ. Before we can establish anti-retinal AAbs as a biomarker for SLE, we must more fully understand their typical prevalence in SLE patients. To evaluate our hypothesis, the Specific Aims of our proposal are to: 1. Determine the cross-sectional frequency of anti-retinal AAbs in a cohort of 285 SLE patients and 100 healthy age-matched controls, and to determine the relationship of antibodies with a) the length of exposure to HCQ and b) relationship with abnormalities on retinal screening tests, and. 2. Prospectively examine the impact of HCQ on antiretinal antibody formation and conditions leading to antibody formation by testing antibody formation before and after initiation of HCQ.
Document Details
- Document Type
- Technical Report
- Publication Date
- Sep 01, 2021
- Accession Number
- AD1166780
Entities
People
- Maureen Mcmahon
Organizations
- University of California, Los Angeles