Successful use of tocilizumab in a patient with rheumatoid arthritis following severe pancytopenia during etanercept therapy

Balázs Szalay, Lilla Ács, Barna Vásárhelyi, László Kovács, Attila Balog

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7 Citations (Scopus)


Severe cytopenia, including neutropenia and anemia, may occasionally occur during anti-tumor necrosis factor α (TNF-α) therapy. However, its mechanism is poorly understood, and little is known concerning the rationale of the choice of biologic therapy after a severe episode of cytopenia. The authors present the case of a 68-year-old rheumatoid arthritis patient in whom severe pancytopenia developed soon after the initiation of etanercept therapy. After resolution, the interleukin 6 receptor-blocking agent tocilizumab was introduced, which resulted in long-lasting complete remission of the rheumatoid arthritis without any adverse effects. The apoptosis-inducing effects of 3 TNF-α blockers and tocilizumab on peripheral blood mononuclear cells of the patient were compared by means of annexin V and propidium iodide labeling and flow cytometry. In concert with the clinical events, the anti-TNF-α agents demonstrated significantly higher apoptotic activities than that of tocilizumab. Tocilizumab appeared safe after anti-TNF-α-induced cytopenia possibly caused by apoptosis induction.

Original languageEnglish
Pages (from-to)377-379
Number of pages3
JournalJournal of Clinical Rheumatology
Issue number7
Publication statusPublished - Oct 1 2011



  • apoptosis
  • etanercept
  • pancytopenia
  • rheumatoid arthritis
  • tocilizumab

ASJC Scopus subject areas

  • Rheumatology

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