IMMUNE-MEDIATED ADALIMUMAB-INDUCED THROMBOCYTOPENIA FOR THE TREATMENT OF ULCERATIVE COLITIS
Journal Title: International Journal of Pharmacy and Pharmaceutical Sciences - Year 2015, Vol 7, Issue 7
Abstract
Objective: Tumor-necrosis factor (TNF)-α inhibitors including adalimumab have been widely used for patients with inflammatory bowel diseases refractory to conventional treatment. Neutropenia is the most common side effect of TNF-α inhibitors, but thrombocytopenia is rarely presented. Few cases have been reported on TNF-α-induced thrombocytopenia, but the pathophysiology has not been fully understood. Herein, we explore the pathophysiology of adalimumab-induced thrombocytopenia through the clinical course and treatment options for a patient that developed thrombocytopenia after administration of adalimumab.Methods: We report a singular case of a patient with refractory ulcerative colitis who developed retinal hemorrhages due to thrombocytopenia after receiving adalimumab. The patient’s platelet count continued to drop despite discontinuation of adalimumab and platelet transfusion administration. Thrombocyopenia stabilized only after receiving intravenous immunoglobulin and prednisone. Laboratory tests identified anti-platelet IgM, but no antibody reactivity was seen against platelets in the presence of adalimumab (anti-platelet-adalimumab complex).Results: The patient’s response to immunosuppressants and lack of antibody against adalimumab-platelet complexes (drug-induced thrombocytopenia or type II hypersensitivity reaction) suggests that adalimumab can induce destruction of platelets through the formation anti-platelet antibodies. This is likely caused by immune system derangement in the setting of a chronic inflammatory state, as seen with ulcerative colitis, including an antigenic mimicry of adalimumab against a surface epitope of platelets or adalimumab-induced T-cell apoptosis.Conclusion: Physicians are to be aware of a life-threatening complication of adalimumab, immune-mediated thrombocytopenia for the treatment of ulcerative colitis.Â
Authors and Affiliations
Sunyoung Lee, Michael Chary, Ilnaz Salehi, Raghav Bansal
Keywords
Related Articles
- EP ID EP578603
- DOI -
- Views 65
- Downloads 0
PRELIMINARY INVESTIGATION OF THE MUCOADHESIVE PROPERTIES OF THERMALLY MODIFIED MUCIN ON METRONIDAZOLE TABLETS
Objective: To determine the effect of thermal treatment of mucin on the mucoadhesive and tablet parameters of metronidazole tablets.Methods: Mucin was extracted from the giant African snails (Archachatina maginata) by di...
ANTIOXIDANT, DNA DAMAGE PROTECTIVE AND HEPATOPROTECTIVE ACTIVITIES OF AMORPHOPHALLUS CAMPANULATUS
Objective: Amorphophallus campanulatus (AC) is commonly known as Suran. It is used to cure piles, deranged digestion and liver diseases. The present study was carried out to evaluate AC plant as a new source of natural b...
PHARMACIST INTERVENTION AND PREPARATION OF MANUAL IN THE ADMINISTRATION OF DRUGS THROUGH ENTERAL FEEDING TUBE
Objective: To monitor errors in current practice and prepare a manual for proper drug administration through the enteral feeding tube.Methods: It is a prospective observational study conducted for a period of 6 mo in eig...
IMPACT ON PROLINE CONTENT OF JATROPHA CURCAS IN FLY ASH AMENDED SOIL WITH RESPECT TO HEAVY METALS
Objective: To reveal the property of Jatropha curcas, to retain itself under the heavy metal stress of high concentration of fly ash through the increase in proline content in plants.Methods: A pot culture experiment was...
DECOLOURIZATION OF TRIPHENYLMETHANE DYES AND DYE INDUSTRY EFFLUENT BY STAPHYLOCOCCUS AUREUS ISOLATED FROM DYE CONTAMINATED SITE
Objective: The objectives of the present study were a) to isolate and screen bacteria for dye removal from synthetic solution b) to optimize various variables such as pH, static/shaking and initial dye concentration on d...