Can Adalimumab (adalimumab) cause leukopenia and neutropenia?

Adalimumab and Hematologic Adverse Effects

Yes, adalimumab can cause leukopenia and neutropenia, though these are relatively infrequent hematologic adverse reactions that require monitoring and possible discontinuation if significant abnormalities develop. 1

Hematologic Complications of Adalimumab

• The FDA label specifically lists "medically significant cytopenia (e.g., thrombocytopenia, leukopenia)" as infrequent but documented adverse reactions associated with adalimumab products 1
• Rare reports of pancytopenia including aplastic anemia have been reported with TNF blocking agents like adalimumab 1
• The causal relationship between these hematologic abnormalities and adalimumab remains unclear in some cases, but monitoring is recommended 1
• Hematologic adverse effects are relatively uncommon compared to other side effects such as injection site reactions and infections 2

Clinical Presentation and Risk Factors

• Patients may develop signs and symptoms suggestive of blood dyscrasias including persistent fever, bruising, bleeding, and pallor 1
• Concomitant use of other immunosuppressive medications may increase the risk of hematologic complications 2
• The risk of neutropenia is significantly higher when adalimumab is used in combination with anakinra (an interleukin-1 antagonist) 1
• There have been case reports of severe thrombocytopenia in patients receiving adalimumab, including immune-mediated mechanisms 3, 4

Monitoring and Management

• Patients should be advised to seek immediate medical attention if they develop signs and symptoms suggestive of blood dyscrasias 1
• Consider discontinuation of adalimumab therapy in patients with confirmed significant hematologic abnormalities 1
• While specific laboratory monitoring intervals are not mandated in guidelines, periodic blood count monitoring is prudent, especially in patients with risk factors 5
• The American Society of Clinical Oncology recommends consulting with hematology specialists if serious hematologic adverse effects occur 2

Clinical Implications

• When severe cytopenias occur, they can lead to serious complications including febrile neutropenia and increased infection risk 6
• Some cases of adalimumab-induced thrombocytopenia may be resistant to initial treatments and require more aggressive interventions such as intravenous immunoglobulin 3
• In cases of suspected drug-induced thrombocytopenic microangiopathy, prompt discontinuation of adalimumab is necessary 7
• Platelet counts typically normalize after adalimumab discontinuation in cases of drug-induced thrombocytopenia 4

Prevention and Risk Mitigation

• Before initiating adalimumab, baseline complete blood count should be obtained 5
• Avoid combining adalimumab with anakinra due to increased risk of serious infections and neutropenia 1
• Patients with a history of significant hematologic abnormalities should be monitored more closely if adalimumab therapy is initiated 1
• Consider alternative biologics in patients with pre-existing cytopenias or history of drug-induced hematologic abnormalities 5