Anagrelide

Anagrelide was approved by the FDA in March 1997 for thrombocythaemia secondary to myeloproliferative neoplasms, to reduce elevated platelet counts and the risk of thrombosis and to ameliorate thrombo-haemorrhagic symptoms, on open-label studies in which the majority of patients achieved platelet responses; the EU authorised Xagrid in November 2004 as second-line therapy for at-risk essential thrombocythaemia patients intolerant of or not adequately controlled by their current therapy. The UK PT-1 trial found hydroxyurea plus aspirin superior to anagrelide plus aspirin for arterial thrombosis and myelofibrotic transformation, so hydroxycarbamide remains first line and anagrelide is used in younger patients or when hydroxycarbamide fails. Palpitations, headache, fluid retention and, rarely, cardiomyopathy are the main adverse effects.