Blood Adv

Drug-induced erythrocytosis: Systematic review highlights diagnostic and management challenges

June 3, 2025

Study details: This systematic review followed PRISMA guidelines to evaluate 45 studies (from 2,036 screened) on drug-induced erythrocytosis. The included studies covered testosterone (n=35), SGLT-2 inhibitors (n=5), antiangiogenic tyrosine kinase inhibitors (TKIs; n=3), erythropoiesis-stimulating agents (n=1), and a multidrug-resistant TB regimen (n=1).

Results: Testosterone therapy, especially IM and higher-dose regimens, was associated with erythrocytosis rates up to 66.7% in cisgender and transgender men, with older age as an additional risk factor. Thromboembolic events occurred in up to 2.7% of testosterone users. SGLT-2 inhibitors induced erythrocytosis in 2.1% to 22% of users, with resolution upon drug discontinuation; thromboembolic events were reported in up to 10%. Antiangiogenic TKIs (e.g., lenvatinib) led to erythrocytosis in up to 43.5% of cancer patients. Across drug classes, there was marked heterogeneity in diagnostic criteria and management approaches.

Clinical impact: Drug-induced erythrocytosis is a heterogeneous and under-recognized condition with variable thrombotic risk. The review highlights the need for standardized diagnostic criteria and management strategies, especially as use of implicated medications rises.

Source:

Liu J, et al. (2025, April 24). Blood Adv. Diagnosis, management, and outcomes of drug-induced erythrocytosis: a systematic review.https://pubmed.ncbi.nlm.nih.gov/39913688/