Clinical aspects in patients with rheumatoid arthritis complicated with lymphoproliferative disorders without regression after methotrexate withdrawal and treatment for arthritis after regression of lymphoproliferative disorders.
Identifieur interne : 000502 ( 2020/Analysis ); précédent : 000501; suivant : 000503Clinical aspects in patients with rheumatoid arthritis complicated with lymphoproliferative disorders without regression after methotrexate withdrawal and treatment for arthritis after regression of lymphoproliferative disorders.
Auteurs : Kazuhisa Nakano [Japon] ; Kazuyoshi Saito [Japon] ; Aya Nawata [Japon] ; Kentaro Hanami [Japon] ; Satoshi Kubo [Japon] ; Ippei Miyagawa [Japon] ; Yoshihisa Fujino [Japon] ; Shingo Nakayamada [Japon] ; Yoshiya Tanaka [Japon]Source :
- Modern rheumatology [ 1439-7609 ] ; 2020.
Abstract
Objectives: To identify predictive factors for lymphoproliferative disorders (LPDs) that persist after methotrexate (MTX) withdrawal (Persistent-LPD) and the optimal treatment for rheumatoid arthritis (RA) after LPD regression.Methods: Among 3666 patients with RA treated with MTX in our department from 2006 to 2017, 26 cases of LPD that regressed after MTX withdrawal (Regressive-LPD) and 25 cases of Persistent-LPD were compared. Multivariate logistic analysis was performed to identify predictive factors for Persistent-LPD. Retention rates of biological disease-modifying antirheumatic drugs (bDMARDs) were calculated using the Kaplan-Meier Method.Results: In Persistent-LPD, the incidence of diffuse large B-cell lymphoma was higher (76%). The overall 2-year survival rate was 83.9%: 95.8% for Regressive-LPD and 71.0% for Persistent-LPD. The International Prognostic Index (IPI) risk classification was useful for predicting Persistent-LPD. bDMARDs were introduced in 38 RA patients after LPD regression. Unadjusted retention rate of bDMARDs in the 51 LPD patients was significantly lower than that in the 1668 non-LPD RA patients in our bDMARD cohort (controls) (p = 0.029). The 1-year retention rates for bDMARDs were 69% and 64% for tocilizumab and abatacept, respectively vs. 46% for TNF-inhibitor (TNFi).Conclusion: Risk assessment using IPI predicted Persistent-LPD. After LPD regression, non-TNFi tended to have higher retention rates.
DOI: 10.1080/14397595.2020.1741870
PubMed: 32159414
Affiliations:
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sortKey="Fujino, Yoshihisa" sort="Fujino, Yoshihisa" uniqKey="Fujino Y" first="Yoshihisa" last="Fujino">Yoshihisa Fujino</name><affiliation wicri:level="1"><nlm:affiliation>Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.</nlm:affiliation><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka</wicri:regionArea><wicri:noRegion>Fukuoka</wicri:noRegion></affiliation></author><author><name sortKey="Nakayamada, Shingo" sort="Nakayamada, Shingo" uniqKey="Nakayamada S" first="Shingo" last="Nakayamada">Shingo Nakayamada</name><affiliation wicri:level="1"><nlm:affiliation>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, 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type="wicri:Area/2020/Extraction">000502</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Clinical aspects in patients with rheumatoid arthritis complicated with lymphoproliferative disorders without regression after methotrexate withdrawal and treatment for arthritis after regression of lymphoproliferative disorders.</title><author><name sortKey="Nakano, Kazuhisa" sort="Nakano, Kazuhisa" uniqKey="Nakano K" first="Kazuhisa" last="Nakano">Kazuhisa Nakano</name><affiliation wicri:level="1"><nlm:affiliation>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.</nlm:affiliation><country xml:lang="fr">Japon</country><wicri:regionArea>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka</wicri:regionArea><wicri:noRegion>Fukuoka</wicri:noRegion></affiliation></author><author><name sortKey="Saito, Kazuyoshi" sort="Saito, Kazuyoshi" uniqKey="Saito K" first="Kazuyoshi" last="Saito">Kazuyoshi Saito</name><affiliation wicri:level="1"><nlm:affiliation>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.</nlm:affiliation><country xml:lang="fr">Japon</country><wicri:regionArea>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka</wicri:regionArea><wicri:noRegion>Fukuoka</wicri:noRegion></affiliation></author><author><name sortKey="Nawata, Aya" sort="Nawata, Aya" uniqKey="Nawata A" first="Aya" last="Nawata">Aya Nawata</name><affiliation wicri:level="1"><nlm:affiliation>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.</nlm:affiliation><country xml:lang="fr">Japon</country><wicri:regionArea>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka</wicri:regionArea><wicri:noRegion>Fukuoka</wicri:noRegion></affiliation></author><author><name sortKey="Hanami, Kentaro" sort="Hanami, Kentaro" uniqKey="Hanami K" first="Kentaro" last="Hanami">Kentaro Hanami</name><affiliation wicri:level="1"><nlm:affiliation>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.</nlm:affiliation><country xml:lang="fr">Japon</country><wicri:regionArea>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka</wicri:regionArea><wicri:noRegion>Fukuoka</wicri:noRegion></affiliation></author><author><name sortKey="Kubo, Satoshi" sort="Kubo, Satoshi" uniqKey="Kubo S" first="Satoshi" last="Kubo">Satoshi Kubo</name><affiliation wicri:level="1"><nlm:affiliation>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.</nlm:affiliation><country xml:lang="fr">Japon</country><wicri:regionArea>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka</wicri:regionArea><wicri:noRegion>Fukuoka</wicri:noRegion></affiliation></author><author><name sortKey="Miyagawa, Ippei" sort="Miyagawa, Ippei" uniqKey="Miyagawa I" first="Ippei" last="Miyagawa">Ippei Miyagawa</name><affiliation wicri:level="1"><nlm:affiliation>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.</nlm:affiliation><country xml:lang="fr">Japon</country><wicri:regionArea>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka</wicri:regionArea><wicri:noRegion>Fukuoka</wicri:noRegion></affiliation></author><author><name sortKey="Fujino, Yoshihisa" sort="Fujino, Yoshihisa" uniqKey="Fujino Y" first="Yoshihisa" last="Fujino">Yoshihisa Fujino</name><affiliation wicri:level="1"><nlm:affiliation>Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.</nlm:affiliation><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka</wicri:regionArea><wicri:noRegion>Fukuoka</wicri:noRegion></affiliation></author><author><name sortKey="Nakayamada, Shingo" sort="Nakayamada, Shingo" uniqKey="Nakayamada S" first="Shingo" last="Nakayamada">Shingo Nakayamada</name><affiliation wicri:level="1"><nlm:affiliation>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.</nlm:affiliation><country xml:lang="fr">Japon</country><wicri:regionArea>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka</wicri:regionArea><wicri:noRegion>Fukuoka</wicri:noRegion></affiliation></author><author><name sortKey="Tanaka, Yoshiya" sort="Tanaka, Yoshiya" uniqKey="Tanaka Y" first="Yoshiya" last="Tanaka">Yoshiya Tanaka</name><affiliation wicri:level="1"><nlm:affiliation>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.</nlm:affiliation><country xml:lang="fr">Japon</country><wicri:regionArea>The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka</wicri:regionArea><wicri:noRegion>Fukuoka</wicri:noRegion></affiliation></author></analytic><series><title level="j">Modern rheumatology</title><idno type="eISSN">1439-7609</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><b>Objectives:</b> To identify predictive factors for lymphoproliferative disorders (LPDs) that persist after methotrexate (MTX) withdrawal (Persistent-LPD) and the optimal treatment for rheumatoid arthritis (RA) after LPD regression.<b>Methods:</b> Among 3666 patients with RA treated with MTX in our department from 2006 to 2017, 26 cases of LPD that regressed after MTX withdrawal (Regressive-LPD) and 25 cases of Persistent-LPD were compared. Multivariate logistic analysis was performed to identify predictive factors for Persistent-LPD. Retention rates of biological disease-modifying antirheumatic drugs (bDMARDs) were calculated using the Kaplan-Meier Method.<b>Results:</b> In Persistent-LPD, the incidence of diffuse large B-cell lymphoma was higher (76%). The overall 2-year survival rate was 83.9%: 95.8% for Regressive-LPD and 71.0% for Persistent-LPD. The International Prognostic Index (IPI) risk classification was useful for predicting Persistent-LPD. bDMARDs were introduced in 38 RA patients after LPD regression. Unadjusted retention rate of bDMARDs in the 51 LPD patients was significantly lower than that in the 1668 non-LPD RA patients in our bDMARD cohort (controls) (<i>p</i> = 0.029). The 1-year retention rates for bDMARDs were 69% and 64% for tocilizumab and abatacept, respectively vs. 46% for TNF-inhibitor (TNFi).<b>Conclusion:</b> Risk assessment using IPI predicted Persistent-LPD. After LPD regression, non-TNFi tended to have higher retention rates.</div></front></TEI><affiliations><list><country><li>Japon</li></country></list><tree><country name="Japon"><noRegion><name sortKey="Nakano, Kazuhisa" sort="Nakano, Kazuhisa" uniqKey="Nakano K" first="Kazuhisa" last="Nakano">Kazuhisa Nakano</name></noRegion><name sortKey="Fujino, Yoshihisa" sort="Fujino, Yoshihisa" uniqKey="Fujino Y" first="Yoshihisa" last="Fujino">Yoshihisa Fujino</name><name sortKey="Hanami, Kentaro" sort="Hanami, Kentaro" uniqKey="Hanami K" first="Kentaro" last="Hanami">Kentaro Hanami</name><name sortKey="Kubo, Satoshi" sort="Kubo, Satoshi" uniqKey="Kubo S" first="Satoshi" last="Kubo">Satoshi Kubo</name><name sortKey="Miyagawa, Ippei" sort="Miyagawa, Ippei" uniqKey="Miyagawa I" first="Ippei" last="Miyagawa">Ippei Miyagawa</name><name sortKey="Nakayamada, Shingo" sort="Nakayamada, Shingo" uniqKey="Nakayamada S" first="Shingo" last="Nakayamada">Shingo Nakayamada</name><name sortKey="Nawata, Aya" sort="Nawata, Aya" uniqKey="Nawata A" first="Aya" last="Nawata">Aya Nawata</name><name sortKey="Saito, Kazuyoshi" sort="Saito, Kazuyoshi" uniqKey="Saito K" first="Kazuyoshi" last="Saito">Kazuyoshi Saito</name><name sortKey="Tanaka, Yoshiya" sort="Tanaka, Yoshiya" uniqKey="Tanaka Y" first="Yoshiya" last="Tanaka">Yoshiya Tanaka</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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