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 63
- Downloads 0
REPRODUCTIVE AND DEVELOPMENTAL TOXICITY OF EURYCOMA LONGIFOLIA AQUEOUS EXTRACT (PHYSTA®) IN WISTAR RATS
Objective: Reproductive and developmental toxicities of Eurycoma longifolia aqueous extract (PHYSTA®) in male and female wistar rats were examined concerning its effect on male and female reproductive performance such a...
CYTOTOXIC ACTIVITY OF ACIDIC RIBOSOME INACTIVATING PROTEINS MIRABILIS JALAPA L. (RIP MJ-C) NANOPARTICLE FORMULATED WITH LOW-CHAIN CHITOSAN AND LOW-METHYLATED PECTIN
Objective: This study aimed to formulate acidic ribosome inactivating protein isolated from Mirabilis jalapa L. (RIP MJ-C) nanoparticle, using low chains chitosan and low methylated pectin, and to evaluate its cytotoxic...
RARE SURVIVAL AFTER SEVERE ALUMINIUM PHOSPHIDEPOISOININGAFTER MYOCARDITISWITH L-CARNITINE AND STEROID
Acute Aluminium Phosphide or Celphos poisoning is a common agrochemical fumigant used commonly in countries like South East Asia and China. It is extremely lethal poison as there is no specific antidote and involvement o...
GC-MS ANALYSIS OF PHYTOCHEMICAL CONSTITUENTS IN LEAF EXTRACTS OF NEOLAMARCKIA CADAMBA (RUBIACEAE) FROM MALAYSIA
Neolamarckia cadamba is one of the medicinal plants used in the treatment of various diseases traditionally. This study was conducted to identify the phytochemical constituents of N. cadamba leaf extracts using gas chrom...
A BATTLE AGAINST AIDS: NEW PYRAZOLE KEY TO AN OLDER LOCK-REVERSE TRANSCRIPTASE
Objective: The reason for the failure of most of the anti-HIV drugs are their poor pharmacokinetics, the poor risk to benefit ratio and the drug resistance. With the objective of developing newer pyrazole scaffolds for e...