Etanercept May Have Caused Aplastic Aanemia in a Patient Treated for Arthritis

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Etanercept May Have Caused Aplastic Aanemia in a Patient Treated for

Arthritis

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=R

Eur J Haematol. 2003;71:396-398.

" Aplastic anemia following administration of a tumor necrosis

factor-alpha inhibitor "

A case report of a patient describes the development of aplastic anaemia

complicated by sepsis after the patient received etanercept, and this

may be the first report of aplastic anaemia associated with tumour

necrosis factor-alpha (TNF-alpha) blockade.

Upregulation of TNF-alpha has been implicated in the pathogenesis of

several inflammatory conditions, including rheumatoid arthritis.

Therapeutic agents that block TNF-alpha activity have shown to be

effective for the treatment of these conditions.

In their report, Kuruvilla, MD, with the University of British

Columbia, Vancouver, Canada, and colleagues describe the case of a

78-year-old man diagnosed with rheumatoid arthritis and treated with

etanercept. The patient was first treated with oral methotrexate. He had

also been treated for hypertension and type 2 diabetes mellitus for

approximately 15 years with no recent changes in doses or medications.

The patient was started on etanercept at a dose of 25 mg subcutaneously

twice a week in May 2002 for symptoms of rheumatoid arthritis in the

hands. In July 2002, after 16 weeks of therapy with etanercept, the

patient developed malaise associated with anorexia and weakness, and was

determined to be pancytopaenic. On arrival, the patient was delirious

and in atrial fibrillation with a rapid ventricular response, requiring

admission to the coronary care unit for rate control.

At last follow up on October 22,2002, 12 weeks after presentation, the

patient remained clinically well with normal blood counts. " This patient

had stable blood counts prior to the institution of therapy with

etanercept. The patient had been maintained on a stable dose of

methotrexate for over 3 years with no significant effects on blood

counts, and other medications were unchanged, " the authors point out.

" Methotrexate or other medications were thus unlikely to be the

causative agent in precipitating aplasia, although a synergistic effect

cannot be ruled out, " they add.

" To our knowledge, this is the first report of aplastic anemia related

to TNF-alpha inhibition. With the increasing use of anti-TNF agents for

a variety of indications, the potential for hematologic toxicity should

be noted and closely monitored, " Dr. Kuruvilla and colleagues conclude.

According to the researchers, the exact mechanism is unclear, but

TNF-alpha is known to affect the growth of haematopoietic stem cells,

which may result in peripheral cytopaenias.