Erythropoietin-Induced Iritis-Like Reaction

Abstract

The present report describes an iritis-like reaction found in 13 patients treated with recombinant human erythropoietin (Eprex), a drug given to hemodialysis patients for their chronic anemia. Among 120 patients being treated by hemodialysis in two centers affiliated with our medical center, ten out of 30 Eprex-treated patients but none of 90 not being treated with Eprex developed this reaction. The observations described support a causal relation between Eprex treatment and the iritis-like reaction. Further investigative effort is needed to establish the mechanism.

Acute onset anterior uveitis after darbepoetin alfa infusion

“…Our patient represents the first described case of likely darbepoetin alfa-induced anterior uveitis. It builds upon the previous reports of epoetin-induced anterior uveitis reported by Beiran et al in 1996 [ 2 ].…”

“…The proportion of uveitis cases attributed to drug-induced uveitis is reportedly less than 0.5 % [ 1 ]. Drug-induced uveitis more typically is caused by intraocular or topical rather than systemic medications [ 2 ]. However, systemic medications have become increasingly recognized as potential causes of uveitis.…”

“…Although not well established, an association between epoetin alfa, a human recombinant erythropoietin, and anterior uveitis has been reported previously in the literature, with 13 patients across three medical centers developing anterior uveitis after receiving epoetin alfa during hemodialysis [ 2 ]. All of these patients were undergoing hemodialysis for end stage renal failure and receiving epoetin alfa for chronic anemia [ 2 ].…”

“…The mechanism by which systemic medications induce ocular inflammation is largely unknown, with the exception of bisphosphonates, which are associated with increased intraocular inflammatory cytokines, elevated C-reactive protein, interleukin-1, and interleukin-6 [ 5 ]. Beiran et al postulated a mechanism whereby erythropoietin could induce an inflammatory effect by altering prostaglandin E levels, breaking down the tight junctions that form the blood-aqueous barrier [ 2 ]. Darbepoetin alfa and epoetin alfa both have the same native protein sequence, differing only in glycosylation patterns [ 6 ].…”