Optic Neuritis: A Serious Adverse Effect of Etanercept

• Published in: Drug safety Vol. 45; no. 10; p. 1160
• Main Authors: Dahmani, I, Kastalli, S, Charfi, O, Aouinti, I, Zaiem, A, Lakhoua, G, Daghfous, R, Aidli, S E
• Format: Journal Article
• Language: English
• Published: Auckland Springer Nature B.V 01.10.2022
• Subjects: Abnormalities; Acuity; Amputation; Angiography; Arthritis; Diabetes mellitus (insulin dependent); Disorders; Edema; Etanercept; Evolution; Immunology; Methotrexate; Neuritis; Optic neuritis; Patients; Pharmacovigilance; Psoriasis; Psoriatic arthritis; Reintroduction; Rheumatic diseases; Scleritis; Side effects; Skin diseases; Tumor necrosis factor; Uveitis; Vision; Visual acuity; Visual evoked potentials; Visual field; Visual fields
• ISSN: 0114-5916; 1179-1942

Introduction: Etanercept is a TNF-alpha inhibitor with proven efficacy in both rheumatic diseases and psoriasis. In contrast to uveitis and scleritis, which are the most reported ocular adverse reactions with etanercept, optic neuritis has been rarely described. Objective: We hereby report a rare case of optic neuritis secondary to etanercept treatment. Methods: This case was notified to the department of collection and analysis of adverse reactions of the Chalbi BELKAHIA national centre of pharmacovigilance of Tunis, and analysed according to the updated French method of imputability [1] Results: A 34-year-old female patient with type 1 diabetes is followed for 18 years for pustular psoriasis with psoriatic arthritis. She was initially put on ciclosporin and methotrexate without improvement. Treatment with etanercept at a dose of 50 mg/week was then initiated with good cutaneous and articular evolution. After 15 months of treatment, the patient presented an amputation of the left temporal visual field with, on ophthalmological examination, a visual acuity of 8/10, a fundus examination without abnormality with no signs of papillary edema on angiography and a present and symmetrical photomotor reflex. The visual evoked potential, cerebral-medullary MRI, lumbar puncture and the immunological and infectious work-up were without abnormalities. The diagnosis of optic neuritis was retained, etanercept was stopped and evolution was marked by the recurrence of the cutaneous and articular symptomatology with resolution of the visual disorders (visual acuity at 10/10). Later reintroduction of etanercept was marked by reappearance of visual disorders. Conclusion: Optic neuritis remains a serious visual complication. Therefore, a visual field test before and during etanercept treatment is recommended.