What is Aneglide used for?

Anagrelide: Uses and Clinical Applications

Anagrelide is primarily used to reduce elevated platelet counts in patients with essential thrombocythemia (ET) and other myeloproliferative disorders, particularly when patients are at high risk for thrombotic complications or are intolerant to first-line therapies. 1

Primary Indications

• Essential Thrombocythemia (ET): Anagrelide selectively reduces platelet production by inhibiting megakaryopoiesis
• Other Myeloproliferative Disorders (MPDs) with thrombocytosis
• Second-line therapy for patients who:
  • Are intolerant to first-line agents like hydroxyurea
  • Have inadequate platelet control with other therapies
  • Are younger patients where leukemogenic potential of other agents is a concern

Clinical Effectiveness

Anagrelide has demonstrated effectiveness in controlling platelet counts in over 75% of patients with myeloproliferative disorders 2. It works by:

• Selectively inhibiting megakaryocyte maturation
• Reducing platelet production rather than causing general myelosuppression
• Providing platelet-lowering effects without evidence of increased leukemogenic potential

Treatment Considerations

Patient Selection

Anagrelide may be particularly appropriate for:

• Younger patients with ET where long-term leukemogenic risk of hydroxyurea is a concern
• Patients who develop neutropenia or mucocutaneous changes with hydroxyurea
• Patients with venous thrombosis risk (anagrelide showed better prevention of venous thrombosis compared to hydroxyurea) 3

Limitations and Cautions

• Not recommended as first-line therapy for polycythemia vera (PV) 3
• The PT1 study showed higher rates of arterial thrombosis, serious hemorrhage, and transformation to myelofibrosis compared to hydroxyurea plus aspirin 1
• Common side effects include:
  • Headache
  • Palpitations (positive inotropic effects)
  • Fluid retention
  • Diarrhea
  • Abdominal cramps
  • Nausea 3

Dosing Considerations

Anagrelide dosage should be titrated to achieve a platelet count below 600 × 10^9/L, ideally between 130-450 × 10^9/L 2. Dosing is individualized based on patient response and tolerance.

Clinical Practice Guidelines

Current guidelines generally position anagrelide as a second-line agent for essential thrombocythemia, particularly in:

1. Patients who fail or are intolerant to hydroxyurea
2. Younger patients where concerns about long-term leukemogenicity of other agents exist
3. Patients with predominantly venous thrombotic risk

Important Clinical Insight

A significant advantage of anagrelide is that long-term follow-up studies (over 7 years) have not shown increased conversion to acute leukemia in patients treated solely with anagrelide 2. This contrasts with some other cytoreductive agents used in myeloproliferative disorders, making it potentially valuable for younger patients requiring long-term therapy.