Department of Rheumatology, G. Pini Orthopaedic Institute, Milan, Italy
Correspondence to:
A. Marchesoni, Department of Rheumatology, G. Pini Orthopaedic Institute, Via Pini 9, 20122 Milan, Italy. E-mail: marchesoni{at}gpini.it
We read with interest this letter from Menon et al. [1] reporting another case of pancytopenia following infliximab infusion, but this case was a bit different from ours. It concerned a patient with scleroderma (our patient was affected by rheumatoid arthritis), and the pancytopenia was strictly linked to infliximab treatment, whereas the bone marrow toxicity occurring after the infliximab infusion in our patient may have been partially due to the fact that he was being treated with methotrexate and allopurinol and had been receiving leflunomide until a few weeks before the infliximab treatment. As it was not clear which drug(s) or combination of drugs was reponsible for the severe adverse reaction, we stressed the importance of careful patient monitoring when switching from one anti-rheumatic drug to another, especially in the case of the new and powerful immunosuppressive agents. It is interesting to note that both patients had impaired renal function and, although we cannot know whether this condition may be relevant in such cases, in our opinion it must clearly be kept in mind when starting infliximab therapy. At least one lesson that can be learned from these two cases of pancytopenia following infliximab infusion is that such powerful biological agents should be used with caution in rheumatic patients debilitated by other conditions and years of drug therapy.
References