Hydroxychloroquine in the treatment of sarcoidosis-associated uveitis and idiopathic uveitis

Abstract

Background : Uveitis is one of the five leading causes of blindness in developed countries, and adverse effects associated with long-term use of topical or systemic steroids and immunosuppressive agents are notable. The objective was to evaluate the efficacy and safety of hydroxychloroquine (HCQ) in sarcoidosis-associated uveitis (SAU) and idiopathic uveitis (IU). Methods: Monocentric retrospective study including 42 patients with SAU and 15 patients with IU treated with HCQ for at least 6 months between March 2003 and December 2022. The main objective was to determine the success rate of the HCQ at 6 and 12 months, and at the last visit, and was defined as having control of inflammation, no more than 5 mg prednisone daily and less than or equal to 2 drops of dexamethasone phosphate 0.1%, and no treatment failure due to safety. The Fisher’s exact test and the Wilcoxon rank test were used for the comparison of qualitative data and quantitative data respectively. Prednisone dose was compared using a mixed model. Results: The median duration to the last visit was 19.5 [11; 44.8] months in SAU patients and 18 [13; 38] months in IU patients. At the last visit, 55% patients with SAU (including 71% anterior SAU and 100% intermediate SAU) and 40% patients with IU (including 40% anterior IU) were successfully treated with HCQ ; the median prednisone dose decreased from 10 [IQR, 8.0; 27.5] to 4 [IQR, 2.5; 5.75] mg/d and from 15.5 [IQR, 12.5; 19.5] to 3.0 [IQR, 3.0; 5.0] mg/d in SAU and IU patients, respectively. The reduction in median prednisone dose was significant in patients with SAU (p=0.002). The incidence rate ratio of flare was 0.73 (p=0.143) in SAU patients and 0.26 (p < 0.001) in IU patients. Conclusion: HCQ could be an interesting therapeutic option in certain types of SAU and IU. Additionally, HCQ decreased the incidence of flare-ups and the need for oral prednisone in these patients. Trial registration : The present study received approval from the local ethics committee (CPP Sud Est IV) in February 2019 (N° 19-31) and was registered on www.clinicaltrials.gov (NCT03877575).