Resolution of epoetin-induced pure red cell aplasia, successful re-challenge with roxadustat

The application of erythropoietin (EPO) can bring about a rare but serious complication called anti-EPO antibody-mediated pure red cell aplasia (PRCA). Once the disease is diagnosed, EPO administration should be stopped immediately. However, after the removal of the anti-EPO antibody, treating anaemia in these patients with chronic renal disease with EPO therapy is difficult, as restarting EPO therapy risks the recurrence of anti-EPO antibody-mediated PRCA. A 26-year-old man with anaemia related to renal failure, who was administered recombinant human EPO subcutaneously, developed anti-EPO antibody-mediated PRCA. After removal of antibodies by treatment with corticosteroids and cyclosporine, therapy for anaemia of chronic renal disease with roxadustat achieved good results. Roxadustat is a new type of drug for the treatment of anaemia, and it can stimulate endogenous EPO within or near the physiologic range and increase haemoglobin levels.