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Low drug attributability of aplastic anemia in Thailand. The Aplastic
Anemia Study Group
S Issaragrisil, DW Kaufman, T Anderson, K Chansung, T Thamprasit, J Sirijirachai, A Piankijagum, Y Porapakkham, S Vannasaeng, PE Leaverton, S Shapiro and NS Young
Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol
University, Bangkok, Thailand.
From 1989 to 1994, a population-based, case-control study of aplastic
anemia was conducted in Thailand, including the regions of Bangkok,
Khonkaen in the northeast, and Songkla in the south. An annual incidence in
Bangkok of 3.7 cases per million population, about twice as high as in
Western countries, has been reported. To evaluate the etiologic role of
drugs, 253 subjects were compared with 1,174 hospital controls. With
multivariate adjustment for confounding, a significant association was
identified for exposure 2 to 6 months before admission to thiazide
diuretics (relative risk estimate 7.7; 1.5 to 40). There were crude
associations with sulfonamides (relative risk estimate, 7.9; P = 0.004) and
mebendazole (6.3; P = 0.03) (there were insufficient data for multivariate
adjustment). Excess risks for the three drugs were in the range of 9 to 12
cases per million users. There was no significant association with
chloramphenicol, although the multivariate relative-risk estimate was
elevated (2.7; 0.7 to 10). Other drugs that have been reported to increase
the risk of aplastic anemia, such as nonsteroidal anti-inflammatory drugs
and anticonvulsants, were not commonly used. There were no associations
with commonly used drugs, including benzodiazepines, antihistamines, oral
contraceptives, and herbal preparations. For all associated drugs, the
overall etiologic fraction (the proportion of cases attributable to an
exposure) was 5%, compared with 25% in Europe and Israel. Drugs are
uncommon causes of aplastic anemia in Thailand, and their use does not
explain the relatively high incidence of the disease in that country.
Volume 89,
Issue 11,
pp. 4034-4039,
06/01/1997
Copyright © 1997 by The American Society of Hematology
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