Summary of CAD Medications
Avoiding cold conditions, dressing appropriately for the cold, or living in warm climates is often sufficient to manage mild cases of cold agglutinin disease (CAD). However, if you have a more severe case of the disease, you may require medical treatment. Here’s a summary of those medications.
CAD is a rare autoimmune disorder in which exposure to cold temperatures, those between 32 and 50 F (0 and 10 C), causes autoantibodies called cold agglutinins to bind tightly to red blood cells, inducing their lysis (disintegration) and resulting in anemia.
The disease, which commonly affects adults who are middle age or older, may manifest as a primary disease, in which the underlying cause is not known, or as a secondary disease likely due to bacterial, viral, or parasitic infections, certain types of cancer, or other autoimmune diseases.
The treatment of CAD depends on how serious the case is. While the term “cold” mainly refers to the biological properties of the cold agglutinins, rather than to a clinical state, most scientists agree that it makes sense to follow recommendations and protect against exposure to cold.
In secondary CAD, treatments target the underlying disorder and this could be sufficient for symptoms to go away.
There are four main classes of CAD treatments: immunosuppressants, monoclonal antibodies, erythropoietin, and water-soluble vitamins.
This class of medicines suppresses the body’s immune system.
Cyclophosphamide is an immunosuppressant that is usually used alone or in combination with other medications to treat cancer and other disorders. Your doctor may combine it with rituximab when other approaches are ineffective for treating CAD.
Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off harmful antigens.
Rituximab is a first-line CAD treatment. It is an anti-CD20 monoclonal antibody that depletes immune cells called B-cells. Such depletion interferes with the production of cold agglutinins. Over time, this can result in an improvement in hemoglobin levels. A course of treatment is usually one infusion weekly for four weeks.
When rituximab is ineffective by itself, doctors may combine it with a chemotherapeutic agent such as fludarabine, a small molecule the body metabolizes into a molecule that blocks DNA synthesis.
Erythropoietin (EPO) is a hormone that the kidneys produce to make red blood cells. Doctors often prescribe EPOs to treat anemia in CAD.
It typically takes about two to six weeks after starting treatment to see a marked increase in red blood cell counts.
Your doctor may also prescribe folic acid (or vitamin B) supplements because it is essential for the formation of red blood cells.
Last updated: Dec. 17, 2020
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