Sulfasalazine-Induced Pancytopenia Indicative of Bone Marrow Suppression: A Case Report

Alanazi,

doi:10.14740/jmc1767w

Cited by 3 publications

(4 citation statements)

References 13 publications

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“…The diagnosis mostly depends upon biopsy; however, it was not performed in our patient. Another case similar to ours was diagnosed without a biopsy [11]; the hematologic profile being the source of support for the diagnosis.…”

Section: Discussionmentioning

confidence: 64%

Sulfasalazine-induced Pancytopenia Indicating Bone Marrow Suppression: A Rare Pediatric Case Report from Pakistan

Marsia

Mahmood

Raza

et al. 2019

Cureus

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Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic condition in children. The treatment of JIA is mainly by drug therapy, which includes non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs). Sulfasalazine is a DMARD that is used as the second-line of therapy. Although believed to have an effective and safe profile, it has side effects ranging from mild gastrointestinal discomfort to hematopoietic alterations. In this study, we present a case of JIA with sulfasalazine-induced bone marrow suppression in a five-year-old child, which is rarely reported within the pediatric age group across the literature.

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Section: Discussionmentioning

confidence: 64%

Sulfasalazine-induced Pancytopenia Indicating Bone Marrow Suppression: A Rare Pediatric Case Report from Pakistan

Marsia

Mahmood

Raza

et al. 2019

Cureus

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“…The emergence of JAKi for the treatment of RA stimulated discussions around assessing risk of venous thromboembolisms (VTEs), anemia, and infections such as herpes zoster (HZ) ( 2 , 3 , 4 , 5 ). Estimates for comorbidities frequently associated with DMARD therapies exist for malignancies ( 6 , 7 ), VTE (deep‐vein thrombosis [DVT] or pulmonary embolism [PE]) ( 8 , 9 , 10 ), major adverse cardiovascular events (MACE) ( 11 , 12 ), infections ( 2 , 3 , 4 , 5 , 13 , 14 ), and anemia ( 15 , 16 , 17 , 18 ). However, contemporary estimates are lacking by treatment history.…”

Section: Introductionmentioning

confidence: 99%

The Incidence, Prevalence, and Associated Costs of Anemia, Malignancy, Venous Thromboembolism, Major Adverse Cardiovascular Events, and Infections in Rheumatoid Arthritis Patients by Treatment History in the United States

Dore¹,

Antonova

Burudpakdee

et al. 2021

ACR Open Rheumatology

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Objective Comorbidities in rheumatoid arthritis (RA) can influence treatment selection, impact treatment persistency, and increase health care costs. This study assessed the magnitude of comorbidity burden via epidemiology (incidence and prevalence) and associated costs of select comorbidities in RA patients: anemia, malignancy, venous thromboembolism (VTE), major adverse cardiovascular events (MACE), and infections, stratified by history of disease‐modifying antirheumatic drug (DMARD) exposure. Methods From the IQVIA PharMetrics® Plus database, we selected adult patients with RA (2 or more RA diagnostic codes at least 30 days apart) at initiation of a new DMARD (DMARD‐naïve), after the first conventional synthetic DMARD (csDMARD) or after the first biologic DMARD (bDMARD). We assessed pre‐index prevalence (percentage) and on‐treatment incidence (per 100 patient‐years [P100PY]) of the aforementioned comorbidities. For patients with versus without incident conditions, we compared total all‐cause health care costs as unadjusted and adjusted for baseline characteristics and health care costs. Results Prior to initiating a new treatment, among DMARD‐naïve patients (N = 28,201), csDMARD switchers (N = 7,816), or bDMARD switchers (N = 4,656), the overall prevalence ranged from 14.1% to 16.2% (anemia), from 1.3% to 5.2% (malignancy, evaluated in csDMARD and bDMARD switchers), from 1.5% to 2.1% (VTE), from 1.8% to 2.9% (MACE), and from 66.6% to 76.1% (infections). Once on index treatment, overall incidence (P100PY) among the cohorts ranged from 6.9 to 8.9 (anemia), from 2.0 to 2.3 (malignancy), from 0.7 to 0.9 (VTE), from 1.6 to 2.0 (MACE), and from 77.4 to 87.7 (infections). The incident comorbidities (except herpes zoster) were associated with increased adjusted health care costs. Conclusion Anemia, malignancy, VTE, MACE, and infections affect patients with RA at all stages of their treatment journey and are associated with increased health care costs.

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“…14,15 Apart from its other intracellular side effects, NRTIs cause a reduction in mitochondrial population and protein content in addition to increasing apoptotic changes and reducing the skeletal muscle size (a sign that has been taken as one of the indicators of myopathy in patients treated with NRTIs). [14][15][16] So far, no standard management guidelines have been established in the management of these complications of NRTIs. Measures, such as symptomatic management of complications and withdrawal or substitution of the offending NRTI, have been employed in addressing these complications with minimal level of success.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Naringin improves zidovudine- and stavudine-induced skeletal muscle complications in rats

Adebiyi¹,

Adebiyi²,

Owira

2016

Hum Exp Toxicol

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Chronic use of nucleoside reverse transcriptase inhibitors (NRTIs) in managing human immunodeficiency virus (HIV) infection has been associated with several complications. Available management options for these complications have yielded controversial results, thus the need to urgently find newer alternatives. Naringin, a plant-derived flavonoid, has been shown to possess antioxidant and antiapoptotic properties which can be exploited in managing NRTI-induced complications. This study therefore investigated the effects of naringin on some NRTI-induced complications. Forty-nine rats (200–250 g) were divided into seven groups and were orally treated with stavudine (d4T)-only, d4T + naringin, d4T + vitamin E, zidovudine (AZT)-only, AZT + naringin, AZT + vitamin E, and distilled water, respectively. Drugs were administered once daily for 56 days, and oral glucose tolerance tests conducted on day 54 of the experiments and rats were thereafter sacrificed on day 56 by halothane overdose. Plasma samples and the left gastrocnemius muscles were stored at −80°C for further analysis. There was significant glucose intolerance, insulin resistance, oxidative stress, and apoptosis in the skeletal muscles of AZT- or d4T-only–treated rats. Naringin, however, significantly reduced fasting blood glucose and fasting plasma insulin concentrations, mitigated glucose intolerance, and insulin resistance in addition to reducing malondialdehyde and carbonyl protein concentrations when coadministered with either NRTIs. Furthermore, naringin improved antioxidant enzyme activities, reduced skeletal muscle BCL-2-associated X protein expression, and improved B-cell lymphoma-2 protein expression compared to AZT- or d4T-only–treated rats. Naringin ameliorated AZT- and d4T-induced complications and therefore should be further investigated as a possible nutritional supplement in managing HIV infection.

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Sulfasalazine-Induced Pancytopenia Indicative of Bone Marrow Suppression: A Case Report

Cited by 3 publications

References 13 publications

Sulfasalazine-induced Pancytopenia Indicating Bone Marrow Suppression: A Rare Pediatric Case Report from Pakistan

Sulfasalazine-induced Pancytopenia Indicating Bone Marrow Suppression: A Rare Pediatric Case Report from Pakistan

The Incidence, Prevalence, and Associated Costs of Anemia, Malignancy, Venous Thromboembolism, Major Adverse Cardiovascular Events, and Infections in Rheumatoid Arthritis Patients by Treatment History in the United States

Naringin improves zidovudine- and stavudine-induced skeletal muscle complications in rats

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