Treatment of rheumatoid arthritis after regression of lymphoproliferative disorders in patients treated with methotrexate: a retrospective, multi-center descriptive study.

Abstract

OBJECTIVES:

To identify the optimal treatment for rheumatoid arthritis (RA) after the regression of lymphoproliferative disorders (LPDs).

METHODS:

The subjects were 232 patients with RA who developed LPD between 2000 and 2017 at seven hospitals participating in the LPD-WG study. Kaplan-Meier and Cox proportional regression analyses were performed to determine the factors associated with the rate of LPD relapse and the retention of biological disease-modifying antirheumatic drugs (bDMARDs).

RESULTS:

Treatment for RA was resumed in 138 patients after spontaneous regression of LPD after the discontinuation of methotrexate and in 52 patients after chemotherapy for LPD (persistent-LPD). LPD relapses occurred in 23 patients. Not DMARDs use but Hodgkin's lymphoma was identified as a risk factor for LPD relapse. In 88 RA patients treated with bDMARDs [tocilizumab, 39 patients; abatacept 20 patients; tumor necrosis factor inhibitor, 29 patients], the one-year retention rate was 67.8%. The risk factors for discontinuation of bDMARDs were persistent-LPD, non-diffuse large B-cell lymphomas (non-DLBCL), and a high clinical disease activity index (CDAI). Tocilizumab showed the highest retention rate among bDMARDs, particularly in DLBCL.

CONCLUSION:

Although any bDMARD could be used in patients after LPD regression, effectiveness and risk for relapse should be carefully assessed for each LPD subtype.

• Authors: Kazuhisa Nakano, Yoshiya Tanaka, Kazuyoshi Saito, Yuko Kaneko, Shuntaro Saito, Masao Tanaka, Rintaro Saito, Takao Fujii, Nobuo Kuramoto, Naoki Sugimoto, Hideto Takada, Masayoshi Harigai, Sho Sasaki, Yasuo Suzuki
• Journal: Modern rheumatology (Mod Rheumatol) Vol. 32 Issue 1 Pg. 41-49 (01 05 2022) ISSN: 1439-7609 [Electronic] England
• PMID: 33164614 (Publication Type: Journal Article)
• Copyright: © 2020 Japan College of Rheumatology.

Chemical References

• Antirheumatic Agents
• Methotrexate

Topics

• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (complications, drug therapy)
• Humans
• Lymphoproliferative Disorders (chemically induced, etiology)
• Methotrexate
• Neoplasm Recurrence, Local (chemically induced, complications, drug therapy)
• Retrospective Studies