Drug points: Bilateral anterior toxic optic neuropathy and the use of infliximab

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Abstract
Three cases of bilateral optic neuropathy were reported recently to the Netherlands Pharmacovigilance Centre Lareb. Patient 1, a 54 year old man, had blurred vision 34 days after he was given a third dose of infliximab for rheumatoid arthritis. He was also taking leflunomide, prednisone, naproxen, diazepam, fluoxetine, famotidine, and metoprolol, and acetaminophen or codeine. He had 20/30 vision in both eyes. Fundoscopy showed severe disc swelling, and perimetry showed visual field defects, which were most extensive in both lower quadrants. Fluorescein angiography showed capillary dilation and vascular leakage in both optic nerve heads. The patient was treated with steroids, but his vision did not recover. Patient 2, a woman aged 62, had blurred vision 40 days after her third infliximab infusion for rheumatoid arthritis. She was also taking atenolol, enalapril or hydrochlorothiazide, salicylic acid, terfenadine, and rofecoxib. Retinoscopy showed slight swelling of the optic disc in the …