E016 Outcome of retinopathy screening and drug survival in a cohort taking hydroxychloroquine for rheumatological conditions over a 5-year period

Background/Aims Hydroxychloroquine (HCQ) is used in the treatment of rheumatoid arthritis and systemic lupus erythematosus. HCQ retinopathy is an irreversible side effect that may develop over several years. In 2021, the Royal College of Ophthalmology (RCO) recommended eye screening after 5 years of HCQ therapy. This audit aims to prospectively identify patients who require screening after using HCQ for 5 years or more, and the outcome of screening. Methods Eligible patients starting HCQ in 2018 were identified from outpatient pharmacy records and followed for 5 years (2018-2023). Exclusions: those prescribed HCQ for non-rheumatological conditions, duplicates, deceased and those who had not taken the drug despite being dispensed. Patient records were examined for risk factors (Dose>5mg/kg/day, eGFR<60 and concurrent use of tamoxifen). Referrals for screening and their associated outcomes were collated. Results 188 patients started HCQ in 2018. After 56 exclusions, we followed 132 patients for 5 years. By the 5th year, 61 patients (46.2%) remained on the drug and were eligible for retinopathy screening (Table). The median age of the cohort was 55 years (69.7% female). Of the 61 patients, 31 had evidence of screening, whereas the remaining 30 did not have a screening proforma completed/not referred. Of the 31 screened, 15 patients had no evidence of retinopathy. Reassuringly, no patients had evidence of HCQ-induced retinopathy. The remaining 16 (lost referrals/did not attend/rejected/returned due to COVID-19) will subsequently result in the relevant clinician being notified to investigate the need for re-referral. Of the 30 not referred for screening, 6 patients were lost to follow-up, and 11 patients had no reason stated for non-referral, as outlined in the table. These again will be highlighted to the relevant clinician to be reviewed. Conclusion The HCQ drug survival after 5 years of treatment was 46.2%. Screening services can use these figures to plan for future appointment capacity based on prescription rates for new starters. In comparison to other audits, the rate of retinopathy for this cohort taking HCQ is 0%.