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

A DGReview of : " Aplastic anemia following administration of a tumor necrosis

factor-alpha inhibitor "

European Journal of Haematology

12/31/2003

By Emma Hitt, PhD

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.

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