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

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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
JournalModern rheumatology
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • Other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIID-LPDs)
  • biological disease-modifying antirheumatic drugs (bDMARDs)
  • relapse
  • rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology

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