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Article
May 15, 1987

Analgesic Use, Agranulocytosis, and Aplastic Anemia

Author Affiliations

Netherlands Centre for Monitoring of Adverse Reactions to Drugs Leidschendam

Netherlands Centre for Monitoring of Adverse Reactions to Drugs Leidschendam

JAMA. 1987;257(19):2590. doi:10.1001/jama.1987.03390190068009
Abstract

To the Editor.—  I read with great interest the results of the International Agranulocytosis and Aplastic Anemia study.1 This article gives rise, however, to some fundamental questions. First, was the method of calculation used appropriate to the study of a disease (agranulocytosis) that is largely drug induced? Second, what is the real meaning of the rate ratio estimate?Usually, a case-control study is concerned with a naturally occurring disease. The risk to the users of a particular drug is estimated by comparing the ratio of users and nonusers of the drug among cases (a/b) and controls (c/d).However, when patients with systemic diseases that can cause neutropenia are excluded, as was done in this study, the remaining cases of agranulocytosis are largely due to drugs.2 If we focus on a particular drug, say X, then group b can be subdivided into patients with agranulocytosis due to drugs other

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