Four cases of pure red cell aplasia secondary to epoetin , with strong temporal relationships

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Abstract
Recombinant human erythropoietin (epoetin) has been widely and safely used in patients with chronic renal failure for over 10 years, with few complications. Recently, the use of epoetin has been associated with induction of formation of antibodies to erythropoietin (anti-erythropoietin antibodies) and the development of pure red cell aplasia (PRCA) [1,2]. Until September 2002, this syndrome had been reported in 155 patients worldwide, almost all associated with subcutaneous (s.c.) epoetin-α (Eprex®) [3]. In December 2002, the UK Committee on Safety of Medicines (CSM) distributed an urgent communication advising against s.c. use of Eprex in patients with chronic renal disease [4]. This stimulated a reappraisal of erythropoietin prescribing habits, with the reconsideration of epoetin-β (Neorecormon®) and darbepoetin-α (Aranesp®), which rarely have been associated with PRCA [5]. Here, we describe the only patients in the UK who have developed PRCA during administration of epoetin-β (personal communication from Christian Freitag, UK Drug Surveillance, Roche Pharmaceuticals), with a previously unpublished and noteworthy co-incidence in timing.

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