Diagnosis, Management, and Outcomes of Drug-Induced Erythrocytosis: A Systematic Review
Notice bibliographique
Résumé
Background: Secondary erythrocytosis refers to an elevation in hemoglobin > 160 g/L in women or > 165 g/L in men that is not due to an underlying myeloproliferative neoplasm. Medications such as testosterone and sodium-glucose cotransporter-2 (SGLT-2) inhibitors are common causes of secondary erythrocytosis. Current guidelines on the diagnosis and management of drug-induced secondary erythrocytosis are limited, and the risks of thromboembolism, bleeding, and mortality in this population have yet to be fully described. We therefore conducted a systematic review to inform the clinical management of drug-induced erythrocytosis. Methods: Following PRISMA guidelines, we performed a systematic literature search in MEDLINE, EMBASE, CENTRAL (all via Ovid), and Google Scholar. We included adult patients, age 18 years and older, and studies published from 2005 to February 2024. We excluded case reports and case series with fewer than 5 patients. Two reviewers independently screened titles and abstracts of studies, with disagreements resolved by a third party. Data was extracted on variables pertaining to the diagnosis, management, and outcomes of drug-induced erythrocytosis, and were synthesized using descriptive analysis. (PROSPERO CRD42024508643) Results: Our systematic search identified 2,037 studies for screening. Forty-four studies were included in our review, with 35 studies on testosterone and other androgen use, four studies on SGLT-2 inhibitors, three studies on anti-angiogenic tyrosine kinase inhibitors (TKIs), and one study on erythropoiesis-stimulating agents (ESAs). Cis- and transgender men on prescription testosterone had rates of erythrocytosis up to 46.7%, with intramuscular formulations more commonly associated with erythrocytosis, compared to pellet or intranasal formulations. In cisgender men, only one study identified an increased risk of cardiovascular and thromboembolic events associated with erythrocytosis; in transgender men, one study described thromboembolic events in 2.6% of individuals with erythrocytosis while on testosterone. In individuals on SGLT-2 inhibitors, rates of erythrocytosis ranged from 10-22%, with those who discontinued therapy demonstrating improvement or resolution of erythrocytosis; only one patient had a thromboembolic event associated with erythrocytosis, post-renal transplant. Anti-angiogenic TKIs were studied in patients with cancer, with erythrocytosis developing in up to 43.5% of patients, which was managed with dose reduction, phlebotomy, or acetylsalicylic acid for primary thromboprophylaxis. One study examined erythrocytosis in patients receiving ESAs, with 38.5% of patients requiring dose reduction and 23% requiring phlebotomy; no thromboembolic events were recorded. Conclusion: Drug-induced erythrocytosis is a heterogeneous condition for which there is no clear consensus among clinicians about its diagnosis and management. Rates of thromboembolism associated with this condition are low in the existing literature. Dose reduction or discontinuation of the implicated drug appear to be effective in reversing or resolving erythrocytosis; phlebotomy is another commonly used strategy. Further studies are required to clarify the management and outcomes of drug-induced erythrocytosis.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,035 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,008 | 0,006 |
| Bibliométrie | 0,009 | 0,011 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».