Year 2023 / Volume 115 / Number 12
Letter
Tofacitinib-induced eosinophilia

742

DOI: 10.17235/reed.2023.9831/2023

Sara Archer, Daniela Ferreira, Ana Teresa Ferreira, Sofia Ponte, Cidalina Caetano, Marta Salgado, Paula Lago, Isabel Pedroto,

Abstract
Tofacitinib is an oral small molecule JAK inhibitor approved for the treatment of moderate to severe ulcerative colitis (UC). Its efficacy and safety have been demonstrated in phase III clinical trials and supported by real-life data. We report the case of an 18-year-old woman with a 1-year diagnosis of left-sided UC, with multiple admissions due to disease exacerbation or infections, refractory to infliximab (with azathioprine) and currently under treatment with vedolizumab and tacrolimus. She was admitted due to a severe disease exacerbation and, because of a previous history of neuropsychiatric side effects to corticotherapy, tofacitinib was initiated. In the following 6 days, there was no clinical improvement of UC, and serial blood work-up revealed moderate grade persistent peripheral eosinophilia (3000 cells/mm3) and acute kidney injury grade 1 KDIGO. Tofacitinib temporary suspension was decided, with a rapid normalization of renal function/eosinophil levels. Tofacitinib was restarted 2 days after its suspension. However, she developed moderate eosinophilia (2000 cells/mm3) again, which was considered an adverse effect (AE) to tofacitinib, leading to its suspension with eosinophilia resolution. Given the severity of the disease, after a multidisciplinary discussion, it was decided to start high-dose corticotherapy and ustekinumab with maintenance therapy every 4 weeks, and to add tacrolimus. Clinical and biochemical remission were achieved, and the patient was discharged. Three-month follow-up after tofacitinib suspension showed no recrudescence of eosinophilia. Tofacitinib represents a significant advance in the management of UC patients. The drug has a good safety profile with few related AE. This case aims to warn about an adverse reaction to tofacitinib not reported so far, including in a multicenter real-life setting recently published by Hernández et al where eosinophilia is also not described, thus emphasizing the rarity of this AE. To our knowledge this is the first case of tofacitinib-induced eosinophilia in the context of UC. 
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References
1 - Sandborn, W. J., Su, C., Sands, B. E., D'Haens, G. R., Vermeire, S., Schreiber, S., Danese, S., Feagan, B. G., Reinisch, W., Niezychowski, W., Friedman, G., Lawendy, N., Yu, D., Woodworth, D., Mukherjee, A., Zhang, H., Healey, P., Panés, J., & OCTAVE Induction 1, OCTAVE Induction 2, and OCTAVE Sustain Investigators (2017). Tofacitinib as Induction and Maintenance Therapy for Ulcerative Colitis. The New England journal of medicine, 376(18), 1723–1736. https://doi.org/10.1056/NEJMoa1606910
2 - Lasa, J. S., Olivera, P. A., Danese, S., & Peyrin-Biroulet, L. (2022). Efficacy and safety of biologics and small molecule drugs for patients with moderate-to-severe ulcerative colitis: a systematic review and network meta-analysis. The lancet. Gastroenterology & hepatology, 7(2), 161–170. https://doi.org/10.1016/S2468-1253(21)00377-0
3 - Hernández Martínez A, Navajas Hernández P, Martín Rodríguez MDM, et al. Efficacy and safety of tofacitinib in the treatment of ulcerative colitis: real-life experience in Andalusia. Revista Espanola de Enfermedades Digestivas. 2022 Sep;114(9):516-521. DOI: 10.17235/reed.2022.8380/2021. PMID: 35000397.
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Archer S, Ferreira D, Ferreira A, Ponte S, Caetano C, Salgado M, et all. Tofacitinib-induced eosinophilia . 9831/2023


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Publication history

Received: 10/07/2023

Accepted: 18/07/2023

Online First: 04/08/2023

Published: 12/12/2023

Article Online First time: 25 days

Article editing time: 155 days


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