ADHERENCE TO RETINAL SCREENING GUIDELINES IN LUPUS PATIENTS TREATED WITH HYDROXYCHLOROQUINE - DATA FROM HIGHMARK CLAIMS
Bibliographic record
Abstract
PV247 / #135 Poster Topic: AS24 - SLE-Treatment Background/Purpose In 2020, 4 major medical societies taking care of patients on hydroxychloroquine (HCQ) published a joint statement highlighting ophthalmologic screening guidelines to detect retinal toxicity. The risk of HCQ toxicity is less than 2% after 10 years, with up to 8.6% patients affected after 15 years of use. The joint statement recommends baseline retinal screening within few months of HCQ initiation primarily to rule out existing retinal disease that may interfere with future eye exams. After baseline eye exam, screening can be deferred for 5 years and thereafter should be performed annually. An optical testing with Optical Coherence Tomography (OCT) and automated visual fields (VF) are the preferred modalities for evaluation. We studied the real-world compliance to these recommendations in a cohort of lupus patients utilizing Highmark claims data. Methods We conducted a blended retrospective cohort - Highmark claims study of patients with Systemic lupus erythematosus (SLE) receiving treatment with HCQ. Patients with SLE from 1/2016 to 12/2023 were included. Patients over 18 years of age, with diagnosis of lupus, Systemic lupus erythematosus (SLE), lupus nephritis (LN), cutaneous lupus based on ICD 10 codes who had subsequent refills of HCQ were included. These patients were seen at least twice by rheumatology providers in the division of Rheumatology at Allegheny Health Network. Patients on Medicare and Highmark insurance and seeing either Ophthalmologist or Optometrist were included. A Highmark claims data was extracted on this cohort to investigate adherence to baseline eye exam (within 1 year) and yearly screening after 5 years. Results Among 227 patients with SLE, 204 (90%) were female, 179 (79%) were Caucasian, 124 (55%) were active smokers, 26 (11.4%) had chronic kidney disease, 19 (8.3%) had diabetes, 3 (1.3%) had preexisting retinal disease, 50 (22%) patients were on Medicare and 84 (37%) were seen by an Ophthalmologist. Among 227 patients, only 35% received baseline retinal testing upon HCQ initiation (p<0.05). Among those with 5 years of follow-up and 5 yearly visits, adherence was 11.8% (p<0.05) (Figure 1). Insurance type and provider specialty significantly influenced adherence (Figure 2). Medicare Advantage members showed higher adherence compared to commercial insurance, and baseline exams with an ophthalmologist were associated with better adherence (Figure 3). Adherence was not affected by comorbidities, prior retinal disease, or rurality. Figure 1: Compliance rate (%) for yearly screening from year 1 to 5 Figure 2: Higher compliance rate of Medicare members compared to Commercial Insurance Figure 3: Humphrey visual-fields (HVF) and spectral-domain optical coherence tomography (OCT) performance rate by providers Conclusions Our study highlights poor compliance to screening guidelines for monitoring of retinal toxicity in patients with SLE taking HCQ. Improved education for both providers and patients on ophthalmology surveillance is crucial. Quality improvement initiatives will address this healthcare disparity in our system, aiming for safer HCQ prescribing practices.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".