Antiepoetin antibody-related pure red cell aplasia: successful remission with cessation of recombinant erythropoietin alone

Abstract

An elderly patient with pure red cell aplasia (PRCA) with antierythropoietin (anti-EPO) antibodies is described. PRCA due to alloimmunization is a rare and severe complication of recombinant human erythropoietin (rHu-EPO) therapy. Most reported patients with PRCA were cured primarily by immunosuppressive drug therapy. The patient in this case, however, did not want to receive any immunosuppressive drugs. Therefore, rHu-EPO injection was simply discontinued, the severe anemia gradually improved, and the hemoglobin approached normal range. This case is very rare and significant in that there have been few such elderly patients with rHu-EPO-induced PRCA in whom PRCA remission was achieved, with decreasing antibody titers, after cessation of rHu-EPO alone. Further cases are needed to assess how PRCA should be treated in patients with anti-EPO antibodies.

Post-production protein stability: trouble beyond the cell factory

“…Importantly, aggregation does not only render drug inactivation during storage, and fast clearance, reduction of activity, limited bioavailability and proteolytic digestion upon administration, but it also stimulates undesired immunogenicity [55]. This is a critical issue in clinics as severe side effects observed upon prolonged protein administration (as in the case of insulins, interferons, erythropoietin and growth hormone) are antibody-dependent [56-59]. …”

Pure red cell aplasia and anti-erythropoietin antibodies in patients on hemodialysis: a report of two cases and a literature review

“…Some initial measures must be taken as part of the therapy for PRCA related to rhEPO, such as offering blood transfusions to address symptomatic anemia and discontinue the medication. Since PRCA is an autoimmune disease, spontaneous remission usually is not a factor despite reports in the literature 23. Therefore, patients are usually required to take immunosuppressants.…”

Consideration of the Light and Dark Sides of Medicines: The Thalidomide Example

“…The abovementioned ESA improve renal anemia in almost all patients with end-stage renal disease. However, ESA might, though rare, cause hypertension and thromboembolism in some of the patients, and it may very rarely exacerbate anemia in a limited number of patients, inducing the production of autoantibodies against erythropoietin itself [7][8][9]. Among the long list of drug-induced adverse effects worldwide, thalidomide embryopathy (TE) has been one of the most striking disasters after the 2nd World War.…”