Review Article Open Access
Volume 2 | Issue 4 | DOI: https://doi.org/10.33696/immunology.2.034

TNF-alpha Inhibitors and Neutropenia: Current State of Art

  • 1Department of Internal Medicine, Medical Clinic B, University Hospital of Strasbourg, 67084 Strasbourg, France
  • 2Departments of Internal Medicine, University Hospital of Oujda, 59000 Oujda, Morocco
  • 3Department of Rheumatology, University Hospital of Strasbourg, 67084 Strasbourg, France
  • 4Referral Center of Immune Cytopenias, University Hospital of Strasbourg, 67084 Strasbourg, France
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Corresponding Author

Emmanuel Andrès, emmanuel.andres@chru-strasbourg.fr

Received Date: March 02, 2020

Accepted Date: May 18, 2020


To date, neutropenia and agranulocytosis related to TNF-a inhibitors have been discussed infrequently in the literature. In the current paper, a narrative review of the literature was performed on anti-TNF-a inhibitors, including infliximab, adalimumab, etanercept, golimumab, and certolizumab, using the PubMed database of the US National Library of Medicine. The review was restricted to autoimmune and auto-inflammatory diseases or other orphan diseases. In these conditions, transitory Grade 1-2 neutropenia (absolute blood neutrophil count [NC] between 1.5 to 1 x 109/L and NC between1 to 0.5 x 109/L, respectively) related to TNF-a inhibitors are relatively common. Grade 3-4 neutropenia (NC between 0.5 to 0.1 x 109/L and NC <0.1 x 109/L, respectively), or agranulocytosis ( NC = 0.5 x 109/L + fever) with clinical manifestations related to sepsis, is less common, with only a few case reports to date for the majority of TNF-a inhibitors. Neutropenia should be managed depending on clinical severity, with temporary or permanent discontinuation or reduction in dose of the drug, switching from one drug to another of the same or another TNF-a inhibitor class, broad-spectrum antibiotics in case of sepsis, and hematopoietic growth factors (G-CSF) in the more severe cases.


Neutropenia; Agranulocytosis; Idiosyncratic; Biotherapy; Anti-TNF-α agent; Infliximab; Adalimumab; Etanercept; Golimumab; Certolizumab; Princeps; Biosimilar; Autoimmune disease; Auto-inflammatory disorder; Systemic vasculitis; Orphan disease; Hematopoietic growth factor; G-CSF

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