Drug-induced hypereosinophilia related to tocilizumab therapy for rheumatoid arthritis: Fig. 1

Morrisroe, Kathleen; Wong, Melinda

doi:10.1093/rheumatology/kev275

Cited by 16 publications

(10 citation statements)

References 4 publications

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“…Adalimumab-related reports mostly comprised cases with diseases other than RA. According to the eHealthMe database, tocilizumab was the most frequent cause of eosinophilia among those seven biologics; however, there was only one tocilizumab-related report in the literature (18). The time to symptom onset after the administration of each biologic varied.…”

Section: Discussionmentioning

confidence: 99%

Successful Switch to Golimumab for Eosinophilia and Skin Symptoms Related to Multiple Biologics in a Patient with Rheumatoid Arthritis

et al. 2017

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Biologics used in the treatment of rheumatoid arthritis (RA) rarely cause eosinophilia. We herein report a patient with RA being treated with infliximab, adalimumab, and tocilizumab who developed eosinophilia with skin symptoms. Interestingly, the marked eosinophilia and skin symptoms did not reappear after the patient's medication was switched to golimumab. In this case, the presence of biologics-specific antibodies suggested that immunogenicity caused the eosinophilia. Therefore, switching to a biologic with a lower immunogenicity was effective. These findings may be helpful for clinicians treating patients with biologics-induced eosinophilia.

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Section: Discussionmentioning

confidence: 99%

Successful Switch to Golimumab for Eosinophilia and Skin Symptoms Related to Multiple Biologics in a Patient with Rheumatoid Arthritis

et al. 2017

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“…5 Common findings in these studies were generalized skin manifestations, hypereosinophilia and eosinophilic cutaneous infiltrate on biopsy. [6][7][8][9][10] In the SARS-CoV-2-era, the appropriate strategy for the treatment of the cytokine storm is a topic of great interest and awareness of unusual side effects, as that in our report, could help physicians to better manage these critical patients.…”

Section: Referencesmentioning

confidence: 77%

‘Toxic erythema’ and eosinophilia associated with tocilizumab therapy in a COVID‐19 patient

Sernicola

Carnicelli

Fraia

et al. 2020

Acad Dermatol Venereol

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SARS-CoV-2 asymptomatic infection in a patient under treatment with dupilumab Dear Editor, We have read with great interest the letter of the European Task Force on Atopic Dermatitis on SARS-CoV-2 infection and atopic dermatitis published in JEADV (March 2020) 1 in which the authors state: 'Targeted treatment selectively interfering with type-2 inflammation such as dupilumab is not considered to increase the risk for viral infections and might thus be preferred. . .in a situation such as COVID-19 pandemic'. 1 We would like to report the case of a 72-year-old man affected by severe atopic dermatitis (histologically ascertained), who is under treatment with dupilumab since November 2019, with excellent clinical results. At the beginning of SARS-CoV-2 pandemic in Italy, although he was totally asymptomatic for COVID-19, as all the other residents in Vo' Euganeo, a small town near Padua, in the so-called 'Vo' Red Zone' (i.e. restricted area), he was tested with nasopharyngeal swab for SARS-CoV-2 detection and resulted positive. After 20 days of isolation period, the nasopharyngeal swab for SARS-CoV-2 resulted again positive. After 20 more days of isolation, he was tested positive for the third time. Three weeks later, the nasopharyngeal swab for SARS-CoV-2 was finally negative. Notwithstanding the risk factors (i.e. age >65 years and male gender), our patient throughout all this period (9 weeks) remained totally asymptomatic for COVID-19, in good general condition and free of atopic dermatitis. It would seem that treatment with dupilumab, similarly to other antibodies targeting pro-inflammatory cytokines (e.g. adalimumab, infliximab, ustekinumab, secukinumab and guselkumab), does not worsen the condition of patients infected by SARS-CoV-2 or increase the risk of infection by SARS-CoV-2, 2-7 possibly because these antibodies neutralize individual mediators of the inflammation cascade rather than leading to broad immunosuppression. 8 However, of course, more robust clinical data are needed in order to evaluate the safety of dupilumab and of other biologics in patients infected by SARS-CoV-2.

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“…Particularly, anticonvulsants, antibiotics, antirheumatic drugs, and other drugs such as allopurinol have a well-known potential to cause eosinophilia [7]. Beyond them, the possibility that immunosuppressive agents such as MTX, anti-TNF agents, tocilizumab, and tacrolimus may cause eosinophilia was also documented in the medical literature [6,[15][16][17]. Although reports demonstrate eosinophilia may occur during rheumatic diseases RA, SLE, Behçet's disease, etc., it is not accurate to attribute eosinophilia directly to such diseases.…”

Section: Discussionmentioning

confidence: 99%

Evaluation and Differential Diagnosis of Hypereosinophilia in Rheumatology Practice

Teke

Yıldırım

Dinler

et al. 2021

Int Arch Allergy Immunol

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Background: There has been no investigation so far on the prevalence or causes of hypereosinophilia during rheumatic diseases. Objectives: The study aimed to identify the prevalence and causes of hypereosinophilia among the patients followed in a rheumatology department. Methods: The patients aged 18 years or over followed in our rheumatology department between January 2010 and December 2019 who had at least one AEC ≥1,500/µL measurement in their peripheral blood count were identified retrospectively. Results: Over the 10 years, a total of 130,769 peripheral blood counts were performed, of which 3.9% showed eosinophilia and 0.065% showed hypereosinophilia. Hypereosinophilia was identified in 85 patients. The underlying rheumatic disease was determined in 89.4% (n = 76) of patients. Of these, the most frequent one was rheumatoid arthritis at a ratio of 40.8%, followed by eosinophilic granulomatosis with polyangiitis (EGPA) at a ratio of 10.5%. Hypereosinophilia was in primary form in 3.5% of the patients, whereas secondary to another condition in 91.8% (n = 78) of the cases and idiopathic in 4.7% (n = 4) of patients. The most common cause of secondary hypereosinophilia was drug induced, as detected in 61.2%, followed by allergic conditions in 11.5% and EGPA in 9.4%. In 15.2% (n = 13) of the cases, hypereosinophilia was associated with an underlying rheumatic disease. In the cases with drug-induced hypereosinophilia, most often (in 28.8%) methotrexate was the offending agent. Conclusions: Rheumatologists should be cognizant that hypereosinophilia concurrent to rheumatic diseases is usually not due to the underlying rheumatic disease, except for the conventional eosinophil-related rheumatic diseases.

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Drug-induced hypereosinophilia related to tocilizumab therapy for rheumatoid arthritis: Fig. 1

Cited by 16 publications

References 4 publications

Successful Switch to Golimumab for Eosinophilia and Skin Symptoms Related to Multiple Biologics in a Patient with Rheumatoid Arthritis

Successful Switch to Golimumab for Eosinophilia and Skin Symptoms Related to Multiple Biologics in a Patient with Rheumatoid Arthritis

‘Toxic erythema’ and eosinophilia associated with tocilizumab therapy in a COVID‐19 patient

Evaluation and Differential Diagnosis of Hypereosinophilia in Rheumatology Practice

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