Successful Use of Tocilizumab in a Patient With Rheumatoid Arthritis Following Severe Pancytopenia During Etanercept Therapy
- 1 October 2011
- journal article
- case report
- Published by Ovid Technologies (Wolters Kluwer Health) in JCR: Journal of Clinical Rheumatology
- Vol. 17 (7), 377-379
- https://doi.org/10.1097/rhu.0b013e318231fd99
Abstract
Severe cytopenia, including neutropenia and anemia, may occasionally occur during anti-tumor necrosis factor α (TNF-α) therapy. However, its mechanism is poorly understood, and little is known concerning the rationale of the choice of biologic therapy after a severe episode of cytopenia. The authors present the case of a 68-year-old rheumatoid arthritis patient in whom severe pancytopenia developed soon after the initiation of etanercept therapy. After resolution, the interleukin 6 receptor-blocking agent tocilizumab was introduced, which resulted in long-lasting complete remission of the rheumatoid arthritis without any adverse effects. The apoptosis-inducing effects of 3 TNF-α blockers and tocilizumab on peripheral blood mononuclear cells of the patient were compared by means of annexin V and propidium iodide labeling and flow cytometry. In concert with the clinical events, the anti-TNF-α agents demonstrated significantly higher apoptotic activities than that of tocilizumab. Tocilizumab appeared safe after anti-TNF-α-induced cytopenia possibly caused by apoptosis induction.Keywords
This publication has 11 references indexed in Scilit:
- Neutropenia in patients receiving anti–tumor necrosis factor therapyArthritis Care & Research, 2010
- Comparison of tocilizumab monotherapy versus methotrexate monotherapy in patients with moderate to severe rheumatoid arthritis: the AMBITION studyAnnals Of The Rheumatic Diseases, 2009
- Blockade of Interleukin 6 Signaling Induces Marked Neutropenia in Patients with Rheumatoid Arthritis: Figure 1.The Journal of Rheumatology, 2009
- Three significant cases of neutropenia with etanerceptRheumatology, 2007
- Etanercept and adalimumab treatment in patients with rheumatoid arthritis and spondyloarthropathies in clinical practice: adverse events and other reasons leading to discontinuation of the treatmentRheumatology International, 2007
- Problems encountered during anti-tumour necrosis factor therapyBest Practice & Research Clinical Rheumatology, 2006
- Adalimumab induces apoptosis of human monocytes: a comparative study with infliximab and etanerceptAlimentary Pharmacology & Therapeutics, 2005
- Evidence that anti–tumor necrosis factor therapy with both etanercept and infliximab induces apoptosis in macrophages, but not lymphocytes, in rheumatoid arthritis joints: Extended reportArthritis & Rheumatism, 2005
- Investigation of the Prognostic Value of TNF-α Gene Polymorphism among Patients Treated with Infliximab, and the Effects of Infliximab Therapy on TNF-α Production and ApoptosisPathobiology, 2004
- Anemia of chronic disease in rheumatoid arthritis is associated with increased apoptosis of bone marrow erythroid cells: improvement following anti–tumor necrosis factor-α antibody therapyBlood, 2002