Table 1. Case reports of optic neuropathy associated with TNF-α inhibitors: demographics and medication history
Case
#
Age/
Gender
Anti-TNF-α Agent
Indication for anti-TNF-α
Dose Duration of
anti-TNF-α therapy (mo)
Days since last dose
Anti-TNF-α stopped
Therapy Visual Recovery
Concurrent medications: Reference
1 40M infliximab PsA 5 infusions 6 37 NR Steroids complete none (7)
2 68M infliximab Crohns 210mg/tx, x3 infusions (3mg/kg)
3 0 Y Steroids none pantoprazole (8)
3 55M etanercept RA 25mg twice
weekly for almost 3mo
3 7 Y Steroids partial isoniazid, pyridoxine,
piroxicam, omeprazole, deflazacort, recent lefluonomide
(9)
4 21F etanercept JRA NR 9 NR Y Steroids complete celecoxib, lansoprazole (10)
5 54M infliximab RA 3 doses 3 34 NR Steroids none leflunomide, prednisone,
naproxen, diazepam, fluoxetine, famotidine, metoprolol,
acetaminophen, codeine (11)
6 62F infliximab RA 3 doses 3 40 N—worse
after 4th dose
Steroids none atenolol, enalapril HCTZ, salicylic acid, terfenadine, rofecoxib
(11)
7 54M infliximab RA 3 doses 3 14 NR Steroids none prednisone, diclofenac,
and omeprazole
(11)
8 42M etanercept then adalimumab
PsA NR 4 NR Y None partial NR, was on 48mo of
etanercept prior to 4mo of adalimumab
(12)
9 21F etanercept JIA NR 18 NR N Steroids continued
symptoms on etanercept
NSAIDs, sulfasalazine, gold, hydroxychloroquine, local MTX, atenolol, alendronate
(13)
10 43M etanercept unknown NR 2.5 NR NR NR NR Allopurinol, omeprazole,
prednisolone, probenecid, propoxyphene
(14)
11 32M infliximab Crohns 3 infusions (induction)
3 56 Y IFNB complete methylprednisolone (15)
12 40F etanercept RA NR 10 NR NR IFNB,
IVIG, glatiramer
partial Prednisone, nabumetone, alendronate, hydrocodone
(14)
13 21F etanercept JRA NR 7 NR NR steroids none Lansoprazole,
cyclobenzaprine
(14)
14 41F etanercept RA NR NR NR NR steroids complete NR (14)
15 40M adalimumab RA 40mg q2wks
x12mo
12 NR NR None continued
symptoms on
adalimumab, partial recovery
NR (16)
16 55M infliximab Crohn 3 infusions 2 28 Y Steroids partial NR (17)
(induction)
17 45F infliximab Crohn 5mg/kg
infliximab
10 7 Y Steroids complete prior azathioprine, others
NR
(18)
18 12F etanercept JIA NR 2.5 NR Y Steroids complete NR (13)
19 17F etanercept JIA NR 8 NR Y Steroids complete NSAIDs, salazopyrin, MTX,
local steroids in joints
(13)
20 18M etanercept JSpA NR 11 NR Y Steroids complete MTX (13)
21 60F adalimumab RA 40mg SC
q2wks x2mo
2 14 Y Steroids complete prednisolone, L-thyroxin,
diclofenac, sertraline, ramipril, atenolol, MTX
(19)
22 8F etanercept then infliximab
JIA, uveitis, CME
etanercept 0.4mg/kg twice a week, then 5mg/kg infliximab
12 NR Y Steroids partial NR (prior prednisone,
MTX, etanercept for 24mo then 12mo of infliximab)
(20)
23 53F infliximab RA 4 infusions of
150mg
4 NR Y Steroids complete NR (21)
24 61F etanercept RA NR NR NR Y none partial NR (12)
25 27F infliximab, adalimumab
Crohn NR 6 NR Y none complete NR, was on 36mo of
infliximab then 6mo of adalimumab
(12)
26 32F adalimumab RA 40mg q2wks
x23mo
23 14 Y Steroids partial NR (prior MTX) (22)
27 76F infliximab RA NR 20 NR Y Steroids complete NR (prior MTX) (23)
28 14M etanercept IOIS 25mg SC
qweek x16mo
16 60 Y Steroids partial prednisone, MTX (24)
29 55M adalimumab PsA 40mg SC
q2wks x8
4 14 Y Steroids complete simvastatin, atenolol,
aspirin, metformin, steroid skin creams, paroxetine, risperidone, and folate
(24)
30 55F infliximab RA 9 infusions of
240mg (3mg/kg)
6 3 NR Steroids complete MTX (25)
31 44M infliximab UC 6 infusions 12 42 NR Steroids complete azathioprine (26)
32 39F adalimumab granulomatou s uveitis, MFC
40mg SC q2wks
23 14 Y Steroids,
IFNB
none rosuvastatin, hydrocodone (27)
33 50F infliximab Crohns NR NR 21 Y none complete NR (28)
34 51F infliximab UC 4 infusions 2 unclear NR Steroids complete mesalazine, prednisone,
azathioprine
(29)
35 39F infliximab RA 1 infusion 0 3 Y Steroids complete MTX (30)
36 31F etanercept then infliximab (also on isoniazid for +PPD)
RA 3mg/kg
infliximab
3 28 Y Steroids complete isoniazid; recent
etanercept for 3mo prior to infliximab for 3mo
(31)
37 45F infliximab RA 7 doses 13 7 Y Steroids Complete VA
recovered
NR (prior MTX, sulfasalazine)
(32)
IOIS, idiopathic orbital inflammatory syndrome; IVIg, intravenous immunoglobulin; JIA, juvenile idiopathic arthritis; JSpA, juvenile spondylosing arthritis; JRA, juvenile rheumatoid arthritis; MFC, multifocal choroiditis; MTX, methotrexate; NR, not reported; NSAID, nonsteroidal anti-inflammatory; N, no; PsA, psoriatic arthritis; RA, rheumatoid arthritis; TNF-a, tumor necrosis factor–alpha;
VA, visual acuity; UC, ulcerative colitis; Y, yes; SC, subcutaneous; HCTZ, hydrochlorothiazide; IFNB, interferon-beta; CME, cystoid macular edema; PPD, purified protein derivative; RAPD, relative afferent pupillary defect.
but residual RAPD and enlarged blind spot
38 62M golimumab PsA 50mg SC, 3
total doses
3 0 Y Steroids partial tadalafil, clobetasol,
triamcinolone
Index patient
