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Treatment of rheumatoid arthritis after regression of lymphoproliferative disorders in patients treated with methotrexate: a retrospective, multi-center descriptive study
- Source :
- Modern Rheumatology. 32:41-49
- Publication Year :
- 2020
- Publisher :
- Oxford University Press (OUP), 2020.
-
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.
- Subjects :
- 030203 arthritis & rheumatology
medicine.medical_specialty
business.industry
Optimal treatment
Lymphoproliferative disorders
medicine.disease
Lymphoproliferative Disorders
Arthritis, Rheumatoid
03 medical and health sciences
Methotrexate
0302 clinical medicine
Rheumatology
Antirheumatic Agents
hemic and lymphatic diseases
Rheumatoid arthritis
Internal medicine
Humans
Medicine
In patient
030212 general & internal medicine
Neoplasm Recurrence, Local
business
Retrospective Studies
medicine.drug
Subjects
Details
- ISSN :
- 14397609 and 14397595
- Volume :
- 32
- Database :
- OpenAIRE
- Journal :
- Modern Rheumatology
- Accession number :
- edsair.doi.dedup.....8caff1639526ff987a3ddfe674f04c5a