Hematologic side effects of levamisole in the treatment of rheumatoid arthritis
Mielants, H.; Veys, E.M.
Acta Rhumatologica 3(3): 231-240
1979
ISSN/ISBN: 0250-4642 PMID: 11496646 Document Number: 6886
Agranulocytosis, which must be differentiated from leukopenia, is the most severe side-effect of levamisole in the treatment of rheumatoid arthritis. By sending a detailed questionaire to each investigator known to have been confronted with leukotoxic side-effects, data were collected on 88 patients with agranulocytosis, 43 patients with leukopenia and 3 patients with thrombocytopenia. The presence of HLA B27 in seropositive rheumatoid arthritis patients was found to be an important predisposing factor for agranulocytosis. This blood dyscrasia caused by levamisole is similar to the agranulocytosis found with other antirheumatic and antiinflammatory drugs and can be classified as agranulocytosis of the immunological type. In this form no bone marrow toxicity occurs and the agranulocytosis is always spontaneously reversible on discontinuation of the drug. Although the incidence of agranulocytosis does not seem to be reduced by any of the treatment schemes, high risk patients can be detected by the day per week regimen. Treatment with 150 mg levamisole a single day per week, with leukocyte count 10 hours after each intake of the drug, undoubtedly appears to be the most efficient way to prevent agranulocytosis and makes this drug safe in the treatment of rheumatoid arthritis.
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