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Combination of infliximab with thiopurines significantly reduces white cell and neutrophil counts in inflammatory bowel disease patients

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Abstract

Background

The effects of thiopurines on white cell count are well documented.

Objective

We compared the effects of infliximab 5 mg/kg monotherapy and combination of infliximab with thiopurines on the total and differential white cell count (WBC).

Methods

13 IBD patients treated with infliximab monotherapy and 18 IBD patients treated with a combination of infliximab and thiopurines were included in the study. Using retrospective data, cell counts were examined prior to induction of infliximab, and at 6 weeks and 1 year post-induction.

Results

The patients on combination therapy had an absolute WBC at 52 weeks of 5.7 whereas that of patients on Infliximab monotherapy at the same time point was 8.3 with comparable neutrophil count of 3.4 and 5.4. The results showed a significant reduction in white cell count and neutrophils at 6 weeks which persisted at 52 weeks in both groups (p < 0.05) with a greater drop in patients on combination infliximab and thiopurine (p < 0.05) as compared to Infliximab monotherapy. There was no significant change in the lymphocyte count.

Conclusion

Full blood counts should be closely monitored in all patients starting infliximab therapy, in particular patients receiving concomitant thiopurines.

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References

  1. Hanauer SB, Feagan BG, Lichtenstein GR, Mayer LF, Schreiber S, Colombel JF et al (2002) Maintenance infliximab for Crohn’s disease: the ACCENT I randomized trial. Lancet 359:1541–1549

    Article  CAS  PubMed  Google Scholar 

  2. Colombel JF, Sandborn WJ, Reinisch W, Gerassimos J, Mantzaris Kornbluth A et al (2010) New Engl J Med 362:1383–1395

    Article  CAS  PubMed  Google Scholar 

  3. British Society of Gastroenterology Guidelines (http://www.bsg.org.uk/pdf_word_docs/aza_ibd_dr.doc.assesses on 12/07/2015)

  4. Berliner N, Horwitz M, Loughran TP (2004) Congenital and acquired neutropenia. Hematol Am Soc Hematol Educ Program 15:63–79

    Google Scholar 

  5. Cottone M, Kohn A, Daperno M (2010) Age is a risk factor for severe infections and mortality in patients given anti-tumor necrosis factor therapy for inflammatory bowel disease. Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2010.09.026

    PubMed  Google Scholar 

  6. Bathon JM, Martin RW, Fleischmann RM, Tesser JR, Schiff MH, Keystone EC et al (2000) A comparison of etanercept and methotrexate in patients with early rheumatoidarthritis. N Engl J Med 343:1586–1593

    Article  CAS  PubMed  Google Scholar 

  7. Favalli EG, Varenna M, Sinigaglia L (2005) Drug-induced agranulocytosis during treatment with infliximab in enteropathic spondyloarthropathy. Clin Exp Rheumatol 23:247–250

    CAS  PubMed  Google Scholar 

  8. Vidal F, Fontova R, Richart C (2003) Severe neutropenia and thrombocytopenia associated with infliximab. Ann Intern Med 139:W–W63

    Article  PubMed  Google Scholar 

  9. Guiddir T, Frémond ML, Triki TB, Candon S, Croisille L, Leblanc T, de Pontual L (2014) Anti-TNF-α therapy may cause neonatal neutropenia. Pediatrics 134(4):e1189–e1193. doi:10.1542/peds.2014-0054

    Article  PubMed  Google Scholar 

  10. Phelan C, Wooltorton E (2004) Infliximab and serious hematologic events. CMAJ 171:1045

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bessissow T, Renard M, Hoffman I, Vermeire S, Rutgeerts P, Van Assche G (2012) Review article: non-malignant haematological complications of anti-tumour necrosis factor alpha therapy. Aliment Pharmacol Ther 36(4):312–323. doi:10.1111/j.1365-2036.2012.05189.x (Epub 2012 Jun 24)

    Article  CAS  PubMed  Google Scholar 

  12. Coulthard LR, Geiler J, Mathews RJ, Church LD, Dickie LJ, Cooper DL et al (2012) Differential effects of infliximab on absolute circulating blood leucocyte counts of innate immune cells in early and late rheumatoid arthritis patients. Clin Exp Immunol 170(1):36–46

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Fasanmade AA, Adedokun OJ, Ford J, Hernandez D, Johanns J, Hu C et al (2009) Population pharmacokinetic analysis of infliximab in patients with ulcerative colitis. Eur J Clin Pharmacol 65:1211–1228

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Cottone M, Papi C, Orlando A (2010) Infliximab, azathioprine or combination therapy in the treatment of active Crohn’s disease. Expert Rev Gastroenterol Hepatol 4:709–712

    Article  CAS  PubMed  Google Scholar 

  15. Lemann M, Mary JY, Duclos B, Veyrac M, Dupas JL, Delchier JC et al (2006) Infliximab plus azathioprinefor steroid-dependent Crohn’s disease patients: a randomized placebo-controlled trial. Groupe d’Etude Therapeutiquedes Affections Inflammatoires du Tube Digestif (GETAID). Gastroenterology 130:1054–1061

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Gastroenterology, Connolly Hospital, Blanchardstown, Dublin-15, Ireland

    V. Parihar, O. Maceneaney, S. Maguire, C. Garry, M. O’Sullivan, M. Kennedy, K. Safaya, C. Smyth & R. Farrell

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  1. V. Parihar
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  2. O. Maceneaney
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  3. S. Maguire
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  4. C. Garry
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  5. M. O’Sullivan
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  6. M. Kennedy
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  7. K. Safaya
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  8. C. Smyth
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  9. R. Farrell
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Correspondence to V. Parihar.

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Parihar, V., Maceneaney, O., Maguire, S. et al. Combination of infliximab with thiopurines significantly reduces white cell and neutrophil counts in inflammatory bowel disease patients. Ir J Med Sci 186, 329–332 (2017). https://doi.org/10.1007/s11845-016-1469-8

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  • DOI: https://doi.org/10.1007/s11845-016-1469-8

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