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

Abstract

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.

Analysis of hematological parameters in rheumatoid arthritis patients receiving biological therapy: contribution to prevention of avoidable hematological complications

“…Thus, physiologically higher levels of eosinophils in blood seem to have a positive role in the treatment of RA. On the other hand, BT-induced eosinophilia, described also in our observation, was related with skin symptoms and hypersensitivity (Azuma et al, 2017[ 3 ]).…”

“…Several studies linked the presence of hematological disorders with RA disease activity, treatment prognosis, the onset of additional hematological abnormalities, or with conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) co-treatment (Autrel-Moignet and Lamy, 2014[ 2 ]; Azuma et al, 2017[ 3 ]; Bessissow et al, 2012[ 6 ]; Boilard et al, 2012[ 7 ]; Hensel et al, 2017[ 20 ]). The results presented here have shown that BT may contribute to disruption of hematological homeostasis, which could be followed by the onset of side effects and lead to therapy switch.…”

A Rare Case of Hyper-Eosinophilic Syndrome Associated with Hydrocephalus and Erythroderma

“…The patient took oral prednisolone (1 mg/kg/day) (8). However, this treatment did not result in his dramatic response; hence, we added hydroxyurea (3 g/day) (9, 10) accompanied by MTX (17.5 mg single weekly dosage), folic Acid (1 mg/day), and golimumab (50 mg SC qMonth) (11). Two months later, his motion problem symptoms improved, and it led to a gradual reduction of redness in his skin.…”