阿达木单抗引起血小板减少的文献分析

Literature analysis of adalimumab-induced thrombocytopenia

目的探讨阿达木单抗引起血小板减少的临床特征、机制及治疗方案。方法以“阿达木单抗”和“血小板减少”以及“adalimumab AND thrombocytopenia”检索常用中英文数据库,时间为建库至2021年10月30日。选择报道阿达木单抗引起血小板减少的研究,记录患者的基本情况、基础疾病、用药情况、不良反应出现时间及表现、治疗方案、临床转归及不良反应可能发生机制。结果纳入英文文献12篇,均为个案报道,有效病例12例。多数病例采取标准治疗方案,出现不良反应最短为首次用药后15 d,最长为使用药物3年后。血小板计数的最低值为1×10^(9)·L^(-1)。多数患者均有临床出血或血栓性事件。进行机制推测的报道中主要认为是免疫相关的血小板减少症。治疗方案包括单纯停药,或使用血浆置换,或联合糖皮质激素和免疫球蛋白。报道案例均有较好的预后,恢复时间从数日到数月不等。结论阿达木单抗引起血小板减少为罕见的药物不良反应,但可能引起严重的后果,临床应予以关注。对于既往使用同类药物发生不耐受的患者,不建议使用该药。

AIM To explore the clinical features,mechanism and treatment plan of patients with adalimumabinduced thrombocytopenia.METHODS The commonly used Chinese and English databases with"adalimumab AND thrombocytopenia"from the establishment of the database to October 30,2021 were searched.Patients with thrombocytopenia caused by adalimumab were searched and record patients’basic condition,underlying disease,medication status,time and manifestation of adverse reactions,treatment plans,clinical outcome and possible mechanism adverse reactions.RESULTS Totally 12 English literatures were included,all of which were case reports,with 12 valid cases.Most cases had adopted standard treatment plans.The shortest adverse reaction was 15 d after the first medication,and the longest was 3 years later.The lowest index of platelet count was 1×10^(9)·L^(-1).Most patients had clinical bleeding and thrombotic events.Reports of speculative mechanisms were almost all immune-related thrombocytopenia.Treatment options included simply discontinuing the drug,or using plasma exchange,or a combination of glucocorticoids and immunoglobulin.The recovery time ranged from several days to several months.CONCLUSION Adalimumab-induced thrombocytopenia is a rare adverse reaction,and clinical attention should be paid to it.It is not recommended to use this drug in patients who have been intolerant to similar drugs in the past.