Epoetin-α/epoetin-β

Reactions 1350 - 7 May 2011 S Epoetin-α/epoetin-β Pure red cell aplasia: case report A 36-year-old woman developed pure red cell aplasia during treatment with erythropoiesis-stimulating agents epoetin-α and epoetin-β [time to reaction onset not clearly stated]. The woman, who had chronic kidney disease caused by immunoglobulin A (IgA) nephropathy, was admitted with severe anaemia in July 2002. In October 2000, she started receiving SC epoetin-α 4000 IU/week [Epokine] for anaemia. In January 2002, she started receiving haemodialysis, and her epoetin-α dosage was 3000-6000 IU/week. Eleven months later, her haemoglobin decreased to 5.3 g/dL, despite receiving epoetin-α 12 000 IU/week. She received a blood transfusion consisting of two units of packed red blood cells every three weeks. Laboratory tests were consistent with pure red cell aplasia. In June 2003, a competition enzyme-linked immunoassay showed 1.9 times higher anti-EPO antibody titer. The woman’s pure red cell aplasia was unresponsive to oxymetholone from June to July 2003. She remained transfusion-dependent and restarted epoetin-α [Espogen] from January 2004. But, she did not respond and epoetin-α was switched to SC epoetin-β [Recormon]; her anaemia improved slightly. However, her haemoglobin levels decreased to 5.3 g/dL in April 2005, despite receiving epoetin beta at a dose up to 15 000 IU/week. In June 2005, she started receiving darbepoetin-α, but her anaemia did not improve. Darbepoetin-α was switched to epoetin-β [dosage not stated] and her haemoglobin levels decreased in April 2006. Darbepoetin-α was restarted and her haemoglobin levels slowly recovered. In July 2007, anti- EPO antibodies were still detectable, but the concentration was too low for titration. Author comment: "[W]e have reported a rare case of [erythropoiesis-stimulating agent]-induced [pure red-cell aplasia] that improved successfully following the reintroduction of darbepoetin-α without further immunosuppression in the presence of a low level of anti- darbepoetin-α antibodies." Lee H, et al. Improvement in erythropoieis-stimulating agent-induced pure red-cell aplasia by introduction of darbepoetin- when the anti-erythropoietin antibody titer declines spontaneously. Journal of Korean Medical Science 25: 1676-9, No. 11, Nov 2010 - South Korea 803053696 1 Reactions 7 May 2011 No. 1350 0114-9954/10/1350-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved

Upload
vanphuc
Category

Documents
view
213
download
1

Embed Size (px):

Transcript of Epoetin-α/epoetin-β

Reactions 1350 - 7 May 2011

SEpoetin-α/epoetin-βPure red cell aplasia: case report

A 36-year-old woman developed pure red cell aplasiaduring treatment with erythropoiesis-stimulating agentsepoetin-α and epoetin-β [time to reaction onset not clearlystated].

The woman, who had chronic kidney disease caused byimmunoglobulin A (IgA) nephropathy, was admitted withsevere anaemia in July 2002. In October 2000, she startedreceiving SC epoetin-α 4000 IU/week [Epokine] foranaemia. In January 2002, she started receivinghaemodialysis, and her epoetin-α dosage was 3000-6000IU/week. Eleven months later, her haemoglobin decreasedto 5.3 g/dL, despite receiving epoetin-α 12 000 IU/week.She received a blood transfusion consisting of two units ofpacked red blood cells every three weeks. Laboratory testswere consistent with pure red cell aplasia. In June 2003, acompetition enzyme-linked immunoassay showed 1.9times higher anti-EPO antibody titer.

The woman’s pure red cell aplasia was unresponsive tooxymetholone from June to July 2003. She remainedtransfusion-dependent and restarted epoetin-α [Espogen]from January 2004. But, she did not respond and epoetin-αwas switched to SC epoetin-β [Recormon]; her anaemiaimproved slightly. However, her haemoglobin levelsdecreased to 5.3 g/dL in April 2005, despite receivingepoetin beta at a dose up to 15 000 IU/week. In June 2005,she started receiving darbepoetin-α, but her anaemia didnot improve. Darbepoetin-α was switched to epoetin-β[dosage not stated] and her haemoglobin levels decreasedin April 2006. Darbepoetin-α was restarted and herhaemoglobin levels slowly recovered. In July 2007, anti-EPO antibodies were still detectable, but the concentrationwas too low for titration.

Author comment: "[W]e have reported a rare case of[erythropoiesis-stimulating agent]-induced [pure red-cellaplasia] that improved successfully following thereintroduction of darbepoetin-α without furtherimmunosuppression in the presence of a low level of anti-darbepoetin-α antibodies."Lee H, et al. Improvement in erythropoieis-stimulating agent-induced pure red-cellaplasia by introduction of darbepoetin- when the anti-erythropoietin antibody titerdeclines spontaneously. Journal of Korean Medical Science 25: 1676-9, No. 11,Nov 2010 - South Korea 803053696