| |
|
|
|
|
|
|
|||
|
E Baumelou, M Guiguet and JY Mary
INSERM U263, Unite de Recherches Biomathematiques et Biostatistiques,
Universite Paris, France.
Aplastic anemia (AA) is a rare, severe disease of mainly unknown origin.
Numerous case history reports have incriminated drugs in the etiology of
this disease. Because those reports were questionable, a case-control study
was conducted in France between 1985 and 1988. Cases selected from the
national register were eligible for inclusion when at least two blood
lineages were depressed (hemoglobin < or = 10 g/100 mL and reticulocytes
< or = 50 x 10(9)/L, granulocytes < or = 1.5 x 10(9)/L, platelets
< or = 100 x 10(9)/L) and when the bone marrow biopsy was compatible
with the disease. Using a standardized questionnaire, trained investigators
interviewed one AA patient and two groups of controls (two hospitalized
patients and one neighbor of the AA patient) matched for age, sex, and
interviewer. One hundred forty- seven AA patients, 287 hospitalized
controls, and 108 neighbors were interviewed. The occurrence of AA was
analyzed by matched design with relation to medical history and drug use
during the last 5 years, and specifically during the last year. Three times
as many AA patients reported having suffered from clinical hepatitis during
the last 6 months than either type of control. Similarly, a higher
proportion of AA patients reported a history of chronic immune disorder,
mainly rheumatoid arthritis (odds ratio of 6.8), and a previous use of gold
salts and D-penicillamine in the 5 previous years (odds ratio of 4.9 for
each drug). An excess of colchicine and allo/thiopurinol intake in the 5
previous years was observed among the AA patients (odds ratio equal to 4.1
and 3.6, respectively). These results for gold salts, D- penicillamine, and
colchicine were confirmed when looking for drug use within the last year. A
moderate risk was associated with acetaminophen or salicylate intake during
the 5 previous years or during the last year (odds ratio between 1.8 and
2.0). The frequent use of salicylates within the last year was associated
with a high risk of AA (odds ratio of 5.0). A high risk was also associated
with indolic derivative intake but only when comparing AA patients to
neighbor controls. No association could be evidenced with diclofenac
intake, whatever the control group. Differences observed with recently
published studies suggest that targeted studies on each category of drugs
according to the treated pathologies should be initiated.
This article has been cited by other articles:
| |||||||||||
| Copyright © 1993 by American Society of Hematology Online ISSN: 1528-0020 | |||||||||