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. 
Share Button
New comment
Comments
No comments for this article
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.
Related articles

Letter

Perianal Paget’s disease

DOI: 10.17235/reed.2022.9304/2022

Letter

Chinese dragon sign of ulcerative colitis

DOI: 10.17235/reed.2022.9154/2022

Letter

Ulcerative colitis exacerbated by strongyloidiasis

DOI: 10.17235/reed.2022.9044/2022

Letter

DRESS syndrome secondary to carbamazepine

DOI: 10.17235/reed.2022.8977/2022

Review

Clinical settings with tofacitinib in ulcerative colitis

DOI: 10.17235/reed.2022.8660/2022

Letter

Mesalazine induced interstitial pneumonitis in the COVID era

DOI: 10.17235/reed.2022.8635/2021

Letter

The effect of Adacolumn® on ulcerative colitis with COVID-19

DOI: 10.17235/reed.2020.7156/2020

Letter

Sweet syndrome in severe ulcerative flare

DOI: 10.17235/reed.2020.6995/2020

Letter to the Editor

Ulcerative colitis with gastric and duodenal involvement

DOI: 10.17235/reed.2017.4685/2016

Editorial

Specialist care in the management of inflammatory bowel disease

DOI: 10.17235/reed.2016.4628/2016

Original

Mercaptopurine and inflammatory bowel disease: the other thiopurine

DOI: 10.17235/reed.2016.4546/2016

Case Report

Mesalamine-induced myopericarditis - A case report

DOI: 10.17235/reed.2016.4016/2015

Citation tools
Archer S, Ferreira D, Ferreira A, Ponte S, Caetano C, Salgado M, et all. Tofacitinib-induced eosinophilia . 9831/2023


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1744 visits.
This article has been downloaded 148 times.

Statistics from Dimensions


Statistics from Plum Analytics

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


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology