FRI0172 A PROSPECTIVE AUDIT OF A PATIENT COHORT PRESCRIBED HYDROXYCHLOROQUINE FOR RHEUMATOID ARTHRITIS AND OTHER INFLAMMATORY RHEUMATIC DISEASES IN ORDER TO PRIORITISE RETINOPATHY SCREENING AND ESTIMATE THE NEED FOR DRUG EDUCATION APPOINTMENTS
Authors: Brandon Yeo, Audrey Low, Alexandra Chadwick, Sarah Wills
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Hydroxychloroquine (HCQ) is prescribed for rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and inflammatory osteoarthritis (IOA). A potential side effect of HCQ is drug-induced retinopathy, with an increased risk reported for patients taking &gt;5mg/kg/day and those who have renal impairment. In the United Kingdom, the Royal College of Ophthalmologists (RCO) has published new screening guidelines for HCQ, recommending 1) patients receive doses &lt;5mg/kg/day and 2) all patients planning to be on HCQ long term (≥5 years) should receive baseline eye examination ideally within 6 months of starting HCQ and definitely within 1 year. <h3>Objectives:</h3> This audit aimed to: 1) audit dose prescription by body weight, 2) estimate the screening burden on ophthalmology services, 3) estimate service needs for additional drug education appointments to counsel patients starting HCQ. <h3>Methods:</h3> A list of all patients who were started on HCQ from January 2017 to February 2018 was obtained from the outpatient pharmacy at Salford Royal Hospital. Demographic and clinical data were extracted from electronic patient records. High-risk patients were defined as those who were prescribed an initial dose of &gt;5mg/kg/day or those with an eGFR ≤50 ml/min/1.73m<sup>2</sup>. Patients were followed until the most recent follow-up visit by July 2018 to determine drug persistence and reasons for HCQ cessation, if any. <h3>Results:</h3> 177 patients were started on HCQ, with most (62%) diagnosed with rheumatoid arthritis (Table). Most patients were female (76%) and a third (35%) were older than 60 years old. 9 patients (5.1%) had impaired renal function. 83 patients (47%) were prescribed an initial daily dose of HCQ &gt;5mg/kg/day. By July 2018 (follow-up duration 6-19 months), 127 patients (71.8%) remained on HCQ and will need baseline eye screening. The remaining 50 patients (28.2%) stopped HCQ due to inefficacy (7.3%), GI disturbance (3.4%), rash (3.4%). <h3>Conclusion:</h3> Clinicians need to be cognisant of recent guidelines and adjust HCQ dosing to the recommended 5mg/kg/day. Additional specialist pharmacist input for DED (∼12-13 extra appointments per month) is required. Almost a third of the patients had stopped HCQ by July 2018, mostly due to side effects and reported inefficacy. However, a large proportion (71%) of HCQ starters remain on the drug by 6-12 months and will need baseline screening. Ophthalmology services can estimate services and capacity required for baseline HCQ screening per annum. <h3>Reference:</h3> [1] Royal College of Ophthalmology Guideline: Hydroxychloroquine and Chloroquine Retinopathy Screening 2018 <h3>Acknowledgement:</h3> We would like to thank Lloyds Pharmacy of Salford Royal NHS Foundation Trust for providing the data on HCQ prescribing from Jan 2017 to Feb 2018. <h3>Disclosure of Interests:</h3> None declared