Genotype-Phenotype Study of Patients With Plaquenil -Induced Retinal Toxicity, With Evaluation of the ABCA4 Gene

• ClinicalTrials.gov Identifier: NCT01145196
• Recruitment Status: Recruiting
• First Posted: June 16, 2010
• Last Update Posted: May 26, 2023
• Sponsor: National Eye Institute (NEI)
• Information provided by (Responsible Party): National Institutes of Health Clinical Center (CC) ( National Eye Institute (NEI) )

Study Description

Brief Summary:

Background:

- Plaquenil (hydroxychloroquine) is an anti-inflammatory drug that is used to treat some autoimmune diseases such as lupus and rheumatoid arthritis. This drug can damage the retina by causing a condition called plaquenil-induced retinal toxicity, which may lead to vision loss. However, most people taking plaquenil do not develop this problem. Researchers are interested in studying whether differences in a person s genes explain why some people develop plaquenil-induced retinal toxicity while others do not.

Objectives:

- To investigate possible correlations between certain genes or genetic mutations and plaquenil-induced retinal toxicity.

Eligibility:

• Individuals at least 18 years of age who have previously used plaquenil.
• Both individuals who have and have not developed plaquenil-induced retinal toxicity will be eligible for this study.

Design:

• The study requires one or two visits to the National Eye Institute or an outpatient study clinic over a maximum 2-year period.
• Participants will provide a personal and family medical history, and will have a full eye examination.
• Participants will also provide blood samples for testing.
• No treatment will be provided as part of this protocol.

Condition or disease
Genotype; Retinal Disease

Detailed Description:

OBJECTIVE:

The objective of this study is to investigate whether there is a correlation between genetic mutations, beginning with an analysis of ABCA4, and Plaquenil -induced retinal toxicity and to describe the phenotype of Plaquenil -induced retinal toxicity.

STUDY POPULATION:

The study will enroll 100 patients, 18 years of age or older, found to have Plaquenil -induced retinal toxicity. 200 volunteers with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), or Sj(SqrRoot)(Delta)gren s syndrome and history of Plaquenil use, but without evidence of retinal toxicity, will also be recruited.

DESIGN:

The study is an observational study with 1-2 outpatient visits to the NEI clinic or review of medical records for off-site participants. All participants will provide a blood sample for genetic analysis.

OUTCOME MEASURES:

Clinical examination and blood samples will be used for genetic testing and mutation identification. The primary outcome of this study is to identify genetic mutations, starting with those in ABCA4 gene, associated with retinal toxicity in participants with a history of Plaquenil use. Secondary objectives i clude determining the utility of testing metrics in evaluating the presence of retinal toxicity.

Study Design

• Study Type: Observational
• Estimated Enrollment: 300 participants
• Observational Model: Cohort
• Time Perspective: Cross-Sectional
• Official Title: Genotype - Phenotype Study of Patients With Plaquenil-induced Retinal Toxicity
• Actual Study Start Date: August 23, 2010

Groups and Cohorts

Group/Cohort
Affected; Participants affected by Plaquenil induced retinal toxicity
Unaffected; control participants without Plaquenil induced retinal toxicity

Outcome Measures

Primary Outcome Measures :

1. The outcome of this study is to identify genetic mutations, starting with those in ABCA4 gene, associated with retinal toxicity in participants with a history of plaquenil use. [ Time Frame: annually for five years ]
   The outcome of this study is to identify genetic mutations, starting with those in ABCA4 gene, associated with retinal toxicity in participants with a history of plaquenil use.

Secondary Outcome Measures :

1. The secondary outcome of this study is to determine the utility of various testing metrics in evaluating the presence of retinal toxicity. [ Time Frame: annually for five years ]
   The secondary outcome of this study is to determine the utility of various testing metrics in evaluating the presence of retinal toxicity.

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No
• Sampling Method: Non-Probability Sample

Study Population

The study will enroll 100 patients, 18 years of age or older, found to have Plaquenil -induced retinal toxicity. 200 volunteers with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), or Sjogren's syndrome and history of Plaquenil use, but without evidence of retinal toxicity, will also be recruited.

Criteria

-INCLUSION CRITERIA:

1. Affected participants must be 18 years of age or older and have:

   • History of systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) or Sj(SqrRoot)(Delta)gren s syndrome, and
   • History of Plaquenil use, and
   • Evidence of Plaquenil -induced retinal toxicity, based on clinical findings.

2. Unaffected volunteers must be 18 years of age or older and have:

   • History of systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) or Sj(SqrRoot)(Delta)gren s syndrome, and
   • History of Plaquenil use, and
   • No retinal disease upon examination within the last six months.

3. All participants must be able to:

   • Provide their own consent, and
   • Safely provide a blood sample.

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EXCLUSION CRITERIA:

1. Participants with other known (genetic) retinal disease including but not limited to: Stargardt s disease and cone or cone-rod dystrophy whose diagnosis preceded their Plaquenil use. Participants with no known previous genetic diagnosis but with clinical findings associated with a genetic diagnosis, such as parafoveal or macular flecks which are associated with Stargardt s disease or fundus flavimaculatus, will also be excluded.

Contacts and Locations

Contacts

Contact: Faith Chen; (301) 402-1369; chenfa@nei.nih.gov

Contact: Catherine A Cukras, M.D.; (301) 503-1305; cukrasc@mail.nih.gov

Locations

United States, Maryland

National Institutes of Health Clinical Center; Recruiting

Bethesda, Maryland, United States, 20892

Contact: For more information at the NIH Clinical Center contact Office of Patient Recruitment (OPR) 800-411-1222 ext TTY dial 711 ccopr@nih.gov

Sponsors and Collaborators

National Eye Institute (NEI)

Investigators

• Principal Investigator: Catherine A Cukras, M.D.; National Eye Institute (NEI)

More Information

Additional Information:

NIH Clinical Center Detailed Web Page 

Publications:

Levy GD, Munz SJ, Paschal J, Cohen HB, Pince KJ, Peterson T. Incidence of hydroxychloroquine retinopathy in 1,207 patients in a large multicenter outpatient practice. Arthritis Rheum. 1997 Aug;40(8):1482-6. doi: 10.1002/art.1780400817.

HOBBS HE, SORSBY A, FREEDMAN A. Retinopathy following chloroquine therapy. Lancet. 1959 Oct 3;2(7101):478-80. doi: 10.1016/s0140-6736(59)90604-x. No abstract available.

Webster AR, Heon E, Lotery AJ, Vandenburgh K, Casavant TL, Oh KT, Beck G, Fishman GA, Lam BL, Levin A, Heckenlively JR, Jacobson SG, Weleber RG, Sheffield VC, Stone EM. An analysis of allelic variation in the ABCA4 gene. Invest Ophthalmol Vis Sci. 2001 May;42(6):1179-89.

• Responsible Party: National Eye Institute (NEI)
• ClinicalTrials.gov Identifier: NCT01145196
• Other Study ID Numbers: 100140; 10-EI-0140
• First Posted: June 16, 2010
• Last Update Posted: May 26, 2023
• Last Verified: May 12, 2023

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by National Institutes of Health Clinical Center (CC) ( National Eye Institute (NEI) ):

Retinal Disease; Plaquenil-Induced; Natural History

Additional relevant MeSH terms:

Retinal Diseases; Eye Diseases