What is the Role of Race and Ethnicity in the Development Of Thionamide-Induced Neutropenia?

Abstract

Thionamides are anti-thyroid drugs (ATD) used to treat autonomous thyrotoxicosis. Although efficacious, these medications carry a risk of neutropenia or agranulocytosis. Some risk factors for ATD-induced neutropenia have been identified, including dose, age, and female sex, but the role of race and ethnicity has not been well studied. We hypothesize that there will be no effect of race or ethnicity on the change in Absolute Neutrophil Count (ANC) following initiation of ATD therapy.Data from the Electronic Medical Record at UNM HSC were obtained using a standard database query. Inclusion criteria were the prescription of an ATD, an ANC recorded within 30 days of initiating ATD therapy (Pre-ATD), and an ANC recorded 75 -365 days after starting an ANC (Post-ATD). Patients taking other agents known to cause neutropenia were excluded. Racial and ethnic groups were assigned as follows: Hispanic, Non-Hispanic White, Native American, Black/African American, and Asian/Pacific Islander. Post-ATD ANC was defined as the nadir ANC after ATD initiation. "Delta ANC" was defined as ((Post-ATD ANC) -(Pre-ATD ANC)). ANOVA analysis with Bonferroni-adjusted post-hoc testing and multiple regression were performed to examine differences in the mean changes in ANC across ethnic groups.One hundred and twenty-three adult patients met inclusion and exclusion criteria and were included in the analysis. The Native American group showed a significantly greater Post-ATD ANC and Delta-ANC as compared to the other groups (p<0.001). In this cohort of New Mexicans with thyrotoxicosis, Native American race was protective against thionamide-induced neutropenia.

Comparing Antithyroid Drugs vs. Radioactive Iodine in Paediatric Graves’: Literature Review

“…The absence of information on ethnicity is a key point that prevents true generalisability to the general population, as Ehrhart et al suggested in a 2018 article [30]. Ethnicity is not reported in any study, and as they are all conducted in East Asian countries, it can be problematic to assume these results will hold true in the UK, further hindering the strength of its evidence towards its application in the NICE guideline.…”

Physicians' and Patients' Perceptions and Practices Concerning Antithyroid Drug-Induced Agranulocytosis

“…In the end, survey responses were collected and stored electronically for an anonymous analysis. The survey questions were addressed: (1) confirmation of eligibility and consent question; (2) location of residence and practice; (3) specialty; (4) career stage; (5) several patients with hyperthyroidism have been seen in clinic within the previous 12 months; (6) their perception of the frequency of agranulocytosis in patients receiving antithyroid medications; (7) what method(s) are practiced in educating patients about the risk of agranulocytosis when they are receiving antithyroid medications; (8) what they perceive as the common symptoms of agranulocytosis that patients using antithyroid medications may experience, and they should be warned about? ; (9) assuming that there are no other indications, if and when measurements of WBC count in patients using antithyroid medications are requested in the clinic; and finally, (10) if a patient on ATDs develops suspicious symptoms, what would be the most efficient facility to deal with this?…”

“…However, an estimate cannot be made precisely since it is influenced by ethnicity. 8 The serious side effects of ATDs have unpredictable timing and no well-defined risk factors. Therefore, patient education remains critical in managing patients receiving this treatment.…”