既往出现中性粒细胞减少的患者可以重新应用依那西普

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Clin Rheumatol. 2011 Aug 5. [Epub ahead of print]   Re-challenge with Etanercept in patients with Etanercept-induced Neutropenia.   Haroon M, Daly M, Harney S.   Source Department of Rheumatology, Cork University Hospital, Cork, Ireland, mharoon301@hotmail.com.   Abstract TNF blockers have rarely been associated with haematological complications; however, there are scattered case reports of marked neutropenia with their use and necessitating in their withdrawal. We would like to report a series of five patients who developed neutropenia with etanercept use; however, all these patients were re-challenged with etanercept with a mean follow up of 30 months. These patients developed neutropenia within 2 months of starting etanercept. Two patients were eventually taken off etanercept; one of them needed switching to a different form of TNF blockers, and the second patient is in clinical remission with low-dose corticosteroids. All our patients continued to have mild-moderate degree of neutropenia; however, they are being monitored very closely and they are enjoying complete disease remission. It was interesting to note that none of our patients had increased infections during the re-challenge phase, even though they had grade 2 to grade 4 neutropenia. We have re-challenged these patients without any clinical complications, revealing that patients with mild to moderate neutropenia can be safely exposed to TNF blockers as long as they are monitored with regular cell count checks. Although largely noted to be clinically insignificant in our patient series, the potential of drug-induced neutropenia in causing higher rate of infections do exist. Careful clinical and hematologic monitoring is the best way to recognize this adverse event.   PMID: 21818536

既往出现中性粒细胞减少的患者可以重新应用依那西普   Haroon M et al. Clin Rheumatol. 2011 Aug 5.提前在线.     很少见TNF拮抗剂相关血液学并发症的报道。但是，有散发病例报告称TNF拮抗剂应用过程中发生了明显的中性粒细胞减少症，并不得不停止用药。 我们将要报告的是顺序发现的五例患者接受依那西普治疗时发生了中性粒细胞减少，在之后最长达30个月的随访过程中这些患者重新使用依那西普。 这些患者大多在依那西普治疗2个月内发生了中性粒细胞减少症。有两例病人最终停用依那西普，其中之一转换用其它TNF拮抗剂，另一例一直处于临床缓解并用低剂量糖皮质激素维持。我们的所有病人持续有轻中度的中性粒细胞减少，不过他们都处于严密监测之下，他们目前都已经获得完全的疾病缓解。 有趣的是, 在重新接受依那西普治疗过程中我们并未发现感染风险的增加，尽管有的病人中性粒减少已达到2至4级。 我们让这些病人重新使用依那西普但未发生任何临床并发症，这提示只用定期检测外周血细胞计数，轻中度中性粒减少的患者可以接受抗TNF治疗。 尽管我们所观察到中性粒减少症患者大多没有显著临床意义，但由于药物引发中性粒减少所致感染风险增加的可能性还是存在的。定期血液学和仔细的临床检查是发现这类不良事件的最佳途径。