Letter to the editorAdalimumab-induced neutropenia in a patient with rheumatoid arthritis
Introduction
Tumour necrosis factor (TNFα) antagonists had proved their efficiency to treat rheumatoid arthritis and spondylarthropathies. They are generally well tolerated but need to be closely monitored. Side effects such as tuberculosis and injection site reaction are well known [1]. Serious hematological complications had rarely been reported. We describe a patient with rheumatoid arthritis (RA) who developed marked neutropenia during the first 3 months of treatment with adalimumab, a monoclonal humanized anti-TNFα antibody.
Section snippets
Case report
A 55-year-old woman with a 14-year history of seropositive and destructive rheumatoid arthritis (RA) was treated with methotrexate (MTX) and corticosteroids since the last 6 years. The patient had never received any anti-TNFα treatment and had no Sjogren's syndrome. Because RA was not controlled, with high disease activity (DAS28: 6.39), adalimumab (humira® 40 mg/2w) was started with continuation of the same dosage of oral MTX (15 mg/w) and prednisone (5 mg/d). Before starting adalimumab,
Discussion
The term neutropenia is used to define a condition in which circulating neutrophils number is less than 1500/mm3 [2]. Drug-induced neutropenia is a potentially severe adverse effect with a high rate of infections. In our case of neutropenia, the imputability of adalimumab appears clear since no other modification of treatment has been done, since there was a rapid and progressive decrease of neutrophils after its initiation and since there was a rapid normalization of neutrophils count after
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