Toxicity of antimalarials
| Reference | Type of study (follow-up) | n | AM (mean time use) | Age (mean) | Main outcomes | AM toxicity |
| Costedoat et al, 200766 | Prospective cohort (1 year) | 70 SLE | HCQ (7.9 years) | 38 | Cardiotoxicity (ECG) | AVB (0%), minor HCD (4%), myocardiopathy (0%) |
| Leecharonen et al, 200758 | Retrospective (13 years) | 49 SLE | CQ (36 months) | NS | Standard ophthalmological evaluation (corneal deposition and retinopathy) | Corneal deposition 6%, retinopathy 16% |
| Wozniacka et al, 200667 | Prospective cohort (NS) | 28 SLE | CQ (7 months) | 38 | Cardiotoxicity (ECG, 24-h ECG holter) | HCD (0%), tendency higher QTc before and after CQ treatment (363 ms vs 372 ms, p = 0.09) |
| Bonanomi et al, 200664 | Cross-sectional study | 20 SLE | 34 HCQ | 40 | Retinal toxicity | Retinopathy 6% |
| 14 RA | ||||||
| Bezerra et al, 200554 | RCT (clofazimine vs CQ) (6 months) | 33 SLE | 17 CQ | 34 | Adverse events | Headache 2 (12%), nausea 2 (12%), diarrhoea 3 (18%), urticaria 2 (12%) and ocular 0 (0%) in patients treated with CQ |
| Mavrikakis et al, 200359 | Prospective cohort (15 years) | 191 SLE | HCQ (at least 1 year) | 45 | Ophthalmological assessment (Snellen best-corrected visual acuity, Farnsworth D-15 panel test, Rodenstock central visual field testing, fundoscopy, full field electroretinography, fluorescein angiography) | Retinopathy 0.5% |
| Wang et al, 199955 | Prospective cohort study (NS) | 224 SLE | 156 HCQ/CQ (NS) | 34 | Adverse events | Gastrointestinal 11 (7%), myopathy 2 (1.3%), headache 2 (1.3%), retinal toxicity 1 (0,6%), ototoxicity 1 (0,6%), skin rash 1 (0,6%) |
| Aviña-Zubieta et al, 199857 | Retrospective (8 years) | 557 RA | 541 CQ | 47 | Comparison of side effects between CQ and HCQ | Higher frequency of rash (4.3% vs 2%, p<0.05), corneal deposits (7% vs 0.8%, p<0.001), blurred vision (4% vs 1.3%, p<0.01), myopathy (1.1% vs 0%, p<0.03) and total side effects (28.4% vs 14.7%, p<0.001) in patients receiving CQ in comparison with those receiving HCQ |
| 178 SLE | 399 HCQ | Retinopathy | Probable retinopathy in 1/541 CQ (0.18%) and 0/399 HCQ (0%) | |||
| 128 PA | ||||||
| 77 other | ||||||
| Levy et al, 199760 | Retrospective | NS | 1207 HCQ | NS | Retinal toxicity (reviewed by a panel of 5 ophthalmologists) | Definite toxicity 1/1207 (0.08%) |
| Probable toxicity 4/1207 (0.33%) | ||||||
| Spalton et al, 199365 | Retrospective | 82 SLE | HCQ (39 months) | 40 | Retinal toxicity | Retinopathy 0% |
| Morand et al, 199256 | Retrospective | 37 SLE | HCQ (28 months) | 37 | Adverse events | Dermatological 1 (3%), ocular 0 (0%), gastrointestinal 0 (0%) |
| Johnson et al, 198761 | Retrospective | 7 SLE | HCQ with a total dose >1 g (14.2 years) | 42 | Ophthalmological assessment (Snellen chart, Amsler grid testing, Ishihara plates, Farnsworth–Munsell 100 hue test) | Fine granularity of the macular pigment epithelium (n = 2) |
| Fine granularity of the macular pigment epithelium and borderline abnormalities of colour vision, classified as signs of possible early toxicity (n = 1) | ||||||
| Finbloom et al, 198562 | Retrospective (15 years) | 70 SLE | 31 CQ | 42 | Ocular toxicity | 6/31 CQ (19%) |
| 26 RA | 66 HCQ | 39 | 0/66 HCQ (0%) | |||
| 14 Other | 13 CQ+HCQ | NS | ||||
| Frenkel et al, 198263 | Retrospective (15 years) | 100 RA/SLE | HCQ (36 months) | NS | Ocular toxicity | Retinal toxicity 0 (0%) |
AVB, atrioventricular block; CQ, chloroquine; ECG, electrocardiogram; HCD, heart conduction disorders; HCQ, hydroxychloroquine; NS, not specified; PA, paludism; RA, rheumatoid arthritis; RCT, randomised controlled trial; SLE, systemic lupus erythematosus.