Abstract

ANTI- TNF ALPHA DRUGS INDUCED IMMUNE MEDIATED HEMATOLOGICAL TOXICITIES

Muthukumar Mani*, Aswathi G. and Ranjini R.

ABSTRACT

Background: The TNF-a (Tumor Necrosis Factor) inhibitors are widely used in the management of Crohn’s disease, ulcerative colitis, rheumatologic and dermatologic inflammatory diseases. They have proven their safety and efficacy in the treatment of inflammatory diseases. However, these drugs are also associated with the induction of various adverse drug reactions and toxicities. Aim: The aim of our study was to individually review the role of widely prescribed anti TNF-a drugs (Adalimumab, Infliximab, Etanercept) for their immune mediated hematological complications such as thrombocytopenia, neutropenia, thrombosis, hemophilia. Methods: We conducted literature review over various search engine platforms like Google Scholar, PubMed and Micromedex for topics including anti TNF a induced toxicities, Hematological toxicities induced by Anti TNF a drugs, Case studies and case reports on anti TNF a drugs complications. We also searched for case studies on individual drug i.e., Adalimumab, Infliximab and Etanercept induced blood disorders. We retrieved a total of 66 articles to complete this comprehensive review. INFERENCE: The results of our review implied that thrombosis was more prevalent among Adalimumab and Infliximab users and accounted for a total of 40.2% of all cases reviewed. Among Etanercept users, incidence of Neutropenia was quite common. Conclusion: Our study implies the importance and necessity for monitoring of the hematological parameters at baseline and during TNF alpha therapy. Further studies to elucidate the drug reaction with the immune system are necessary.

Keywords: Adalimumab, Infliximab, Etanercept, thrombocytopenia, neutropenia and thrombosis.