Q J Med 2001; 94: 423-428
© 2001 Association of Physicians
Haematopoietic growth factor in antithyroid-drug-induced agranulocytosis
1 From the Departments of Internal Medicine, 2 Internal Medicine and Nutrition and 3 Onco-Hematology, University of Strasbourg, Strasbourg, France
Received 30 March 2001 and in revised form 25 May 2001
Drug-induced agranulocytosis (DIA) is often caused by antithyroid drugs. We retrospectively studied the use of granulocyte colony-stimulating factor (G-CSF) therapy in antithyroid-DIA. Data for 20 patients (10 treated with G-CSF) with antithyroid-DIA (neutrophil count <0.5x109/l) were extracted from a cohort study of DIA patients (n=110). G-CSF (300 µg/day subcutaneously) was used where the neutrophil count was <0.1x109/l, or the patient was aged >70 years, or there were severe features of infection or underlying disease. Mean patient age was 62 years (range 34–87); sex ratio (M/F) was 0.05. Carbimazole (n=19) and benzylthiouracile (n=1) were the causative drugs, at mean doses of 30 mg/day (range 20–60) and 100 mg/day (range 50–150), respectively, for a mean of 37 days (range 31–90). Antithyroid drugs were prescribed for Graves' disease (n=8), thyrotoxicosis related to amiodarone intake (n=6) and multinodular goitre (n=6). Clinical features included isolated fever (n=7), pneumonia (n=5), septicaemia or septic shock (n=5) and acute tonsillitis (n=3). Mean neutrophil count was 0.07±0.1x109/l. No patient died. Mean durations of haematological recovery, antibiotic therapy and hospitalization were significantly reduced with G-CSF: 6.8±4 days vs. 11.6±5; 7.5±3.8 days vs. 12±4.5; and 7.3±4.8 days vs. 13±6.1, respectively (all p<0.05). G-CSF induced flu-like symptoms in 30% of patients, but reduced overall costs.
Address correspondence to Dr E. Andrès, Service de Médecine Interne de la Clinique Médicale B, CHRU de Strasbourg, Hôpital Civil, 1 Place de l'Hôpital, 67 091 Strasbourg Cedex, France. e-mail: emmanuel.andres{at}chru\|[hyphen]\|strasbourg.fr
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