title: Successful use of tocilizumab in a patient with rheumatoid arthritis following severe pancytopenia during etanercept therapy.
abstract: Severe cytopenia, including neutropenia and anemia, may occasionally occur during anti-tumor necrosis factor α (TNF-α) therapy. However, its mechanism is poorly understood, and little is known concerning the rationale of the choice of biologic therapy after a severe episode of cytopenia. The authors present the case of a 68-year-old rheumatoid arthritis patient in whom severe pancytopenia developed soon after the initiation of etanercept therapy. After resolution, the interleukin 6 receptor-blocking agent tocilizumab was introduced, which resulted in long-lasting complete remission of the rheumatoid arthritis without any adverse effects. The apoptosis-inducing effects of 3 TNF-α blockers and tocilizumab on peripheral blood mononuclear cells of the patient were compared by means of annexin V and propidium iodide labeling and flow cytometry. In concert with the clinical events, the anti-TNF-α agents demonstrated significantly higher apoptotic activities than that of tocilizumab. Tocilizumab appeared safe after anti-TNF-α-induced cytopenia possibly caused by apoptosis induction.
authors.affiliation: First Department of Pediatrics, Semmelweis University and Hungarian Academy of Sciences, Budapest, Hungary.
authors.forename: Balázs
authors.initials: B
authors.lastname: Szalay
authors.forename: Lilla
authors.initials: L
authors.lastname: Acs
authors.forename: Barna
authors.initials: B
authors.lastname: Vásárhelyi
authors.forename: László
authors.initials: L
authors.lastname: Kovács
authors.forename: Attila
authors.initials: A
authors.lastname: Balog
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D017209:Apoptosis; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology; D004359:Drug Therapy, Combination; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage / Q000009:adverse effects*; D008727:Methotrexate / Q000008:administration & dosage; D008775:Methylprednisolone / Q000008:administration & dosage; D010198:Pancytopenia / Q000139:chemically induced* / Q000188:drug therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; C502936:tocilizumab; D000068800:Etanercept; D008775:Methylprednisolone; D008727:Methotrexate