Literature case analysis of optic neuritis caused by tumor necrosis factor-α inhibitors
10.3760/cma.j.cn114015-20230202-00047
- VernacularTitle:肿瘤坏死因子α抑制剂相关视神经炎文献病例分析
- Author:
Jianbo SONG
1
;
Liqin ZHAO
;
Min ZHOU
;
Guangying WANG
;
Yuanping LI
;
Hongping WEN
Author Information
1. 山西省人民医院药学部，太原 030012
- Publication Type:Journal Article
- Keywords:
Tumor necrosis factor inhibitors;
Optic neuritis;
Demyelinating diseases;
Multiple sclerosis
- From:
Adverse Drug Reactions Journal
2023;25(8):482-490
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical characteristics of tumor necrosis factor-α (TNF-α) inhibitors-related optic neuritis.Methods:The database at home and abroad (as of November 2022) were searched and the case reports on optic neuritis induced by TNF-α inhibitors were collected. Clinical data including gender, age, use of TNF-α inhibitors, combination drugs, time to onset of optic neuritis, clinical manifestations, results of ancillary examinations, treatment and outcome were extracted and analyzed descriptively.Results:A total of 37 patients were enrolled in the study, including 16 males and 21 females, with an average age of 44 years; 11 patients were treated with adalimumab, 16 with infliximab, 8 with etanercept, 1 with golimumab, and 1 with peselizumab. Among them, 5 patients had previously been treated with other TNF-α inhibitors. The primary disease was rheumatoid arthritis in 15 patients, Crohn′s disease and ulcerative colitis disease in 8 patients, psoriatic arthritis in 3 patients, anterior uveitis in 2 aptients, and other rheumatic and inflammatory diseases in 9 patients. Of them, 4 patients were complicated with other diseases. The median time from TNF-α inhibitors use to optic neuritis occurrence was 4.5 months (3 days to 2 years). The most common clinical manifestations were decreased vision and ocular movement pain. Of the 37 patients, cerebrospinal fluid (CSF) analysis was performed in 8 patients, and 6 were abnormal. CSF oligoclonal bands were detected in 7 patients, and 4 were positive. Magnetic resonance imaging of the brain or orbit was performed in 32 patients, 11 patients showed optic nerve enhancement, 14 patients had brain lesions, and 5 patients had cervical or spinal cord lesions. Visual acuity was examined in 30 patients, 29 of which showed decreased vision. Of the 37 patients, 24 patients stopped the suspected drugs and were treated with glucocorticoid (GC), 6 patients only stopped medication but not treated with GC, and it was not described in 7 patients, 5 of whom were treated with GC. Of the 37 patients, 30 patients recovered partially or completely after discontinuation of the drugs and/or treated with GC, 6 patients were not improved and 1 patient was deteriorated.Conclusions:TNF-α inhibitors-related optic neuritis mostly occurs within the first 6 months of treatment, and more common clinical manifestation is visual acuity loss, with or without brain MRI lesions. Early detection and intervention usually lead to a better prognosis.
