title: Haematopoietic growth factor in antithyroid-drug-induced agranulocytosis.
abstract: Drug-induced agranulocytosis (DIA) is often caused by antithyroid drugs. We retrospectively studied the use of granulocyte colony-stimulating factor (G-CSF) therapy in antithyroid-DIA. Data for 20 patients (10 treated with G-CSF) with antithyroid-DIA (neutrophil count <0.5x10(9)/l) were extracted from a cohort study of DIA patients (n=110). G-CSF (300 microg/day subcutaneously) was used where the neutrophil count was <0.1x10(9)/l, or the patient was aged >70 years, or there were severe features of infection or underlying disease. Mean patient age was 62 years (range 34-87); sex ratio (M/F) was 0.05. Carbimazole (n=19) and benzylthiouracile (n=1) were the causative drugs, at mean doses of 30 mg/day (range 20-60) and 100 mg/day (range 50-150), respectively, for a mean of 37 days (range 31-90). Antithyroid drugs were prescribed for Graves' disease (n=8), thyrotoxicosis related to amiodarone intake (n=6) and multinodular goitre (n=6). Clinical features included isolated fever (n=7), pneumonia (n=5), septicaemia or septic shock (n=5) and acute tonsillitis (n=3). Mean neutrophil count was 0.07+/-0.1x10(9)/l. No patient died. Mean durations of haematological recovery, antibiotic therapy and hospitalization were significantly reduced with G-CSF: 6.8+/-4 days vs. 11.6+/-5; 7.5+/-3.8 days vs. 12+/-4.5; and 7.3+/-4.8 days vs. 13+/-6.1, respectively (all p<0.05). G-CSF induced flu-like symptoms in 30% of patients, but reduced overall costs.
authors.affiliation: Department of Internal Medicine, University of Strasbourg, Strasbourg, France. emmanuel.andres@chru-strasbourg.fr
authors.forename: E
authors.initials: E
authors.lastname: Andrès
authors.forename: J E
authors.initials: JE
authors.lastname: Kurtz
authors.forename: A E
authors.initials: AE
authors.lastname: Perrin
authors.forename: P
authors.initials: P
authors.lastname: Dufour
authors.forename: J L
authors.initials: JL
authors.lastname: Schlienger
authors.forename: F
authors.initials: F
authors.lastname: Maloisel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000380:Agranulocytosis / Q000139:chemically induced / Q000188:drug therapy* / Q000191:economics; D013956:Antithyroid Agents / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011379:Prognosis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D013956:Antithyroid Agents; D016179:Granulocyte Colony-Stimulating Factor