title: Incidence and risk factors for agranulocytosis in Latin American countries--the Latin Study: a multicenter study.
abstract: OBJECTIVE
  LATIN is a multinational case-control study designed to identify risk factors for agranulocytosis and to estimate the incidence rate of the disease in some Latin American countries.
  
  
  METHODS
  Each study site in Brazil, Argentina and Mexico conducted an active search of agranulocytosis patients in hematology clinics and looked for possible associations with drug use.
  
  
  RESULTS
  The overall incidence rate was 0.38 cases per 1 million inhabitant-years. Agranulocytosis patients more often took medications already associated with agranulocytosis than controls (p = 0.01), mainly methimazole (OR 44.2, 95% CI 6.8 to infinity). The population attributable risk percentage (etiologic fraction) was 56%. The use of nutrient supplements was more frequent among patients than controls (p = 0.03).
  
  
  CONCLUSIONS
  Agranulocytosis seems to be very rare in Latin America. The lower than expected number of cases identified during the study period precluded estimation of the risk associated to individual drugs, with the exception of methimazol. However, this is the longest series of agranulocytosis cases ever gathered in Latin America, and information on drug exposures was collected prospectively. The conclusion is that drug-induced agranulocytosis does not seem to be a major public health problem in the study regions.
authors.affiliation: Centro de Pesquisa Clínica, Instituto Israelita de Ensino e Pesquisa Albert Einstein, Piso Chinuch, São Paulo, Brazil. hamer@einstein.br
authors.forename: Nelson
authors.initials: N
authors.lastname: Hamerschlak
authors.forename: Eliane
authors.initials: E
authors.lastname: Maluf
authors.forename: Alexandre
authors.initials: A
authors.lastname: Biasi Cavalcanti
authors.forename: Alvaro
authors.initials: A
authors.lastname: Avezum Júnior
authors.forename: José
authors.initials: J
authors.lastname: Eluf-Neto
authors.forename: Roberto
authors.initials: R
authors.lastname: Passeto Falcão
authors.forename: Irene Gyongyvér Heidemarie
authors.initials: IG
authors.lastname: Lorand-Metze
authors.forename: Daniel
authors.initials: D
authors.lastname: Goldenberg
authors.forename: Cézar
authors.initials: C
authors.lastname: Leite Santana
authors.forename: Daniela
authors.initials: D
authors.lastname: de Oliveira Werneck Rodrigues
authors.forename: Leny
authors.initials: L
authors.lastname: Nascimento da Motta Passos
authors.forename: Erika
authors.initials: E
authors.lastname: Oliveira de Miranda Coelho
authors.forename: Maria Carolina
authors.initials: MC
authors.lastname: Tostes Pintão
authors.forename: Hélio
authors.initials: H
authors.lastname: Moraes de Souza
authors.forename: José Rafael
authors.initials: JR
authors.lastname: Borbolla
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pasquini
mesh_terms: D000368:Aged; D000380:Agranulocytosis / Q000139:chemically induced / Q000453:epidemiology*; D013956:Antithyroid Agents / Q000009:adverse effects; D016022:Case-Control Studies; D002648:Child; D003625:Data Collection; D005260:Female; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008713:Methimazole / Q000009:adverse effects; D008875:Middle Aged; D016273:Occupational Exposure; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D013956:Antithyroid Agents; D008713:Methimazole