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Diagnosing Infection in Tocilizumab Users: What's Helpful?
TOPLINE:
Eosinopenia and low ratio between eosinophil count (EC) and neutrophil count (NC) are potential indicators of infection for patients with inflammatory disease who are treated with tocilizumab.
METHODOLOGY:
- The researchers reviewed data from 163 patients treated for an inflammatory disease (mostly rheumatoid arthritis) with tocilizumab at a single center between 2009 and 2020.
- The study population included 41 patients with unscheduled hospitalizations for suspected infections. Patients' median age was 59 years, and 83% were female.
- The researchers assessed the association in tocilizumab-treated patients between infections and eosinopenia (defined as EC < 0.05 g/L) and a low ratio between EC and NC, defined as EC/NC × 1000 < 11.8.
TAKEAWAY:
- Infectious diseases were diagnosed in 20 of the hospitalized patients (49%); the most common diseases were pneumonia (30%), joint or bone infections (25%), and gastrointestinal tract infections (15%).
- The median absolute EC at hospital admission was significantly lower for patients with infections than for those without infections (0.06 g/L vs 0.20 g/L).
- The median EC/NC × 1000 ratios were significantly lower in infected patients vs noninfected patients (6.54 vs 48.50).
- No differences appeared between patients with and without infections in age, sex, type of inflammatory disease, and steroid treatment.
IN PRACTICE:
"This original study suggests that all those easily available parameters should be used to maximize [sensitivity] in the screening of infection in patients undergoing treatment with IL-6 pathway antagonists," the researchers wrote.
SOURCE:
The lead author on the study was Audrey Glatre, MD, of University Hospital Centre Reims, Reims, France. The study was published online in RMD Open on February 9.
LIMITATIONS:
The retrospective, observational design; relatively small study population; and use of data from a single center were potential limitations of the findings.
DISCLOSURES:
The study received no outside funding. The researchers had no financial conflicts to disclose.
