AB1215 CURRENT PRACTICE OF HYDROXYCHLOROQUINE PRESCRIPTION AND MONITORING IN INDIA -A NATIONAL SURVEY
Authors: Shilpa Jagadeesh, Arumugam Moorthy, B G. Dharmanand
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Hydroxychloroquine was introduced as an antimalarial during World War 2 and since then has found numerous indications for usage as an immonomodulator. Research is ongoing for new uses of the drug. Hydroxychloroquine is generally considered to be safe and monitored less rigorously than other DMARDS that have strict bloods monitoring regimes. Emerging evidence of increased risk of retinal toxicity possibly due to widespread usage in a population with diverse co-morbidity has prompted updates to prescription and monitoring guidelines worldwide. <h3>Objectives:</h3> Evaluate current practice of Hydroxychloroquine prescription and monitoring in secondary care. Understand awareness of cross specialty guidelines. Explore barriers to evidence based monitoring. <h3>Methods:</h3> Questionnaire based survey shared to practicing clinicians(consultant rheumatologists, Immunologists, postgraduate trainees, other clinicians with interest in rheumatology) who prescribe Hydroxychloroquine. Results analyzed through excel spreadsheet and charts. <h3>Results:</h3> We received 61 responses from clinicians nationally.88.5% were consultant rheumatologists,6.6% consultant immunologists and others included clinicians with interest in rheumatology. Special interest was CTD for 47.5% and 36% inflammatory arthritis. All respondents worked in urban areas and average experience in specialty was 9 years. Majority saw in excess of 500 patients month. 61 clinicians saw in excess of 24,700 patients per month and on average started more than 2481 patients on Hydroxychloroquine. Approximate prescription rate was 41 patients per clinician per month. Indications included connective tissue disease and inflammatory arthritis mainly. Other indications include antiphospholipid syndrome, osteoarthritis, post viral arthropathy, dermatomyosistis and diabetic arthropathy. Pretreatment tests as per international guidelines were recommended by 35% clinicians only which includes baseline Optical coherence tomography 25% or eye evaluation by ophthalmologist 10%. 54% clinicians advised OCT after 5 years (47.5%) or formal ophthalmology monitoring(6.5%) in line with published international guidance. Barriers to following required pretreatment tests and monitoring we noted from this survey include lack of awareness or disagreement with guidelines (lack of conclusive data), doubtful cost effectiveness and nonadherence by patients due to cost implications. <h3>Conclusion:</h3> There is need to improve awareness of existing evidence based guidelines on prescription and monitoring of Hydroxychloroquine by international ophthalmology and rheumatology organizations There is more data needed to prove effectiveness of current guidelines beyond doubt. We also need to better counsel and educate patients on the drug so adherence can be improved. <h3>References</h3> [1] https://www.rcophth.ac.uk/wp-content/uploads/2018/07/Hydroxychloroquine-and-Chloroquine-Retinopathy-Screening-Guideline-Recommendations.pdf [2] Ledingham J, Gullick N, et al.BSR and BHPR guideline for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs;Rheumatology 2017; 56: 865–868 <h3>Disclosure of Interests:</h3> Shilpa Jagadeesh : None declared, Arumugam Moorthy Speakers bureau: Speaker fee from Abbvie, Novartis., B G Dharmanand: None declared