Development of peripheral eosinophilia in inflammatory bowel disease patients on infliximab treated at a tertiary pediatric inflammatory bowel disease center is associated with clinically active disease but does not result in loss of efficacy or adverse outcomes

Abstract

Introduction Inflammatory bowel disease (IBD) consisting of Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory conditions affecting the gastrointestinal tract. Infliximab (IFX) is a chimeric anti‐tumor necrosis factor antibody used to treat moderate to severe IBD. Eosinophils are commonly found in chronically inflamed tissues in IBD. Peripheral eosinophilia (PE) was previously implicated as a marker of disease severity at diagnosis. The main aim of this study was to investigate whether in IBD patients on IFX, development of PE is associated with adverse outcomes and poor IFX efficacy. Methods A comprehensive retrospective chart review of IBD patients on IFX (January 2006 to July 2015) treated at a tertiary pediatric IBD center was performed. Data was collected at time specified points over a 24 month period and included demographics, atopy, disease severity, development of PE, human antichimeric antibodies (HACA), infusion reactions, cancer, psoriasis, and loss of clinical response. Results One hundred twenty‐one IBD patients starting IFX (67 male), mean age of 12.4 years (range 4–22 years old), met inclusion criteria. Of them, 36.3% had ≥1 PE episode (CD: 25 male, 11 female; UC: 6 male, 2 female). Mean absolute eosinophil count (AEC) did not change over time. PE was associated with clinically active disease. Among patients who developed PE, adverse outcomes were not significantly different versus those who did not have PE. Conclusions In a cohort of primarily pediatric IBD patients on IFX, PE was associated with clinically active disease; however, PE was not related to increased incidence of adverse outcomes or loss of drug efficacy.

Hypereosinophilic Syndrome Secondary to Ulcerative Colitis and Primary Sclerosing Cholangitis

“…The patient’s symptoms combined with laboratory and imaging tests met the diagnostic criteria for HES. HES is a cause of primary hypereosinophilia and the diagnosis requires the exclusion of secondary causes, such as allergic-mediated, parasitic infections and hematological diseases [3, 7].…”

“…The presence of hypereosinophilia in patients with UC is considered a marker of disease severity at diagnosis. Additionally, it is associated to severe colitis and higher need for surgery [7] .…”

Evaluation and Differential Diagnosis of Hypereosinophilia in Rheumatology Practice

“…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.…”

Resolved Hypereosinophilic Syndrome and Immune Thrombocytopenic Purpura in Ulcerative Colitis Patients Post Colectomy: A Case Series and Literature Review

“…The refractory HES and ITP noted in the described patients do not seem to be cases of idiopathic immune-mediated comorbidities occurring in the context of the systemic immune responses associated with UC flare, as has long been reported in the literature. 49 In our opinion, the two cases represent cases of reactive eosinophilia and thrombocytopenia that occurred secondary to the ongoing local intestinal inflammation. The fact that the two conditions resolved and remained in remission for long periods following colectomy generates a hypothesis about the reactive nature of these conditions.…”