1
|
Faganello D, Bertrand A, Meunier P, Avouac J, Toussirot E, Coury F, Seror R, Le Mélédo G, Germain V, Dellal A, Shima D, Hulin C, Prati C, Schaeverbeke T, Richez C, Truchetet ME, Kostine M. Evolution of monoclonal gammopathy of undetermined significance in patients treated with JAK inhibitors for rheumatic diseases: data from the MAJIK-SFR registry. Rheumatology (Oxford) 2024; 63:787-790. [PMID: 37540112 DOI: 10.1093/rheumatology/kead187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/09/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE Monoclonal gammopathy of undetermined significance (MGUS) is common, but there are scarce data regarding the effect of DMARDs on this premalignant condition. We aimed to evaluate the impact of JAK inhibitors (JAKis) on MGUS when initiated for an active rheumatic disease. METHODS Patients with monoclonal abnormality prior to JAKi initiation for an active rheumatic disease were identified through the MAJIK-SFR Registry, a French multicentre prospective study. Clinical and biological data were collected using a standardized case report form. RESULTS Twenty patients were identified with a mean age of 65 years and a diagnosis of RA (n = 15), PsA (n = 3), and axial SpA (n = 2). The JAKi prescribed was baricitinib (n = 9), tofacitinib (n = 6) or upadacitinib (n = 5), with a mean duration of 15.5 months. Seventeen patients had individualized serum monoclonal protein (IgG kappa n = 9; IgG lambda n = 4; IgM kappa n = 3; IgA lambda n = 1) ranging from 0.16 to 2.3 g/dl, and three patients did not have an initial measurable spike but they had a positive serum immunofixation. With a follow-up of 4-28 months, the serum monoclonal protein level decreased in 8 of 17 patients (47%), remained stable in 8 patients (47%) and increased in 1 patient (6%). The maximal decrease observed was an initial IgG kappa of 2.3 g/dl, decreasing to 0.2 g/dl at month 14. CONCLUSION This study provides reassuring and promising data on MGUS evolution in patients treated with JAKis for rheumatic diseases, which may guide the choice of treatment in patients with both conditions.
Collapse
Affiliation(s)
- Déborah Faganello
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases, Bordeaux University Hospital, Bordeaux, France
| | - Anne Bertrand
- Department of Rheumatology, Suburbain Bouscat Hospital, Le Bouscat, France
| | - Pauline Meunier
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases, Bordeaux University Hospital, Bordeaux, France
| | - Jérôme Avouac
- Department of Rheumatology, APHP University Hospital, Paris, France
| | - Eric Toussirot
- INSERM CIC-1431 Clinical Investigation Center, Besancon University Hospital, Besancon, France
| | - Fabienne Coury
- Department of Rheumatology, Lyon University Hospital, Lyon, France
| | - Raphaele Seror
- Department of Rheumatology, APHP University Hospital, Le Kremlin Bicêtre, France
| | | | | | - Azedinne Dellal
- Department of Rheumatology, Montfermeil Hospital, Montfermeil, France
| | - Ditmar Shima
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases, Bordeaux University Hospital, Bordeaux, France
| | - Cyrille Hulin
- Department of Hematology, Bordeaux University Hospital, Pessac, France
| | - Clément Prati
- Department of Rheumatology, Besancon University Hospital, Besancon, France
| | - Thierry Schaeverbeke
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases, Bordeaux University Hospital, Bordeaux, France
| | - Christophe Richez
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases, Bordeaux University Hospital, Bordeaux, France
| | - Marie-Elise Truchetet
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases, Bordeaux University Hospital, Bordeaux, France
| | - Marie Kostine
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases, Bordeaux University Hospital, Bordeaux, France
| |
Collapse
|
2
|
Cutaneous manifestations of monoclonal gammopathy. Blood Cancer J 2022; 12:58. [PMID: 35411042 PMCID: PMC9001632 DOI: 10.1038/s41408-022-00661-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 12/29/2022] Open
Abstract
Monoclonal gammopathy associated with dermatological manifestations are a well-recognized complication. These skin disorders can be associated with infiltration and proliferation of a malignant plasma cells or by a deposition of the monoclonal immunoglobulin in a nonmalignant monoclonal gammopathy. These disorders include POEMS syndrome, light chain amyloidosis, Schnitzler syndrome, scleromyxedema and TEMPI syndrome. This article provides a review of clinical manifestations, diagnostics criteria, natural evolution, pathogenesis, and treatment of these cutaneous manifestations.
Collapse
|
3
|
Guerin C, Beylot-Barry M, Frouin E, Hainaut E, Masson Regnault M. Treatment of Subcorneal Pustular Dermatosis (Sneddon-Wilkinson Disease) With Anti-Tumor Necrosis Factor Alpha. Cureus 2021; 13:e17147. [PMID: 34532181 PMCID: PMC8435096 DOI: 10.7759/cureus.17147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/29/2022] Open
Abstract
Subcorneal pustular dermatosis (SPD), also known as Sneddon-Wilkinson disease, is a skin condition for which treatments are poorly codified. Anti-tumor necrosis factor alpha (TNFα) efficacy has been reported in multidrug-resistant SPD, as in our two cases. In the first case, an 83-year-old woman was monitored for SPD, associated with monoclonal IgA gammopathy. After multiple-line treatment failure, infliximab (5mg/kg) led to clinical improvement, noted few days following the first injection, and with complete remission at one month. At 12 months, the patient relapsed and concomitant serum anti-TNFα antibodies were found. A switch to adalimumab led to complete remission in three months with a follow-up of six months. In the second case, a 62-year-old woman was monitored for SPD associated with monoclonal IgA gammopathy recalcitrant to different lines of treatment. Treatment with adalimumab (40mg every two weeks) in combination with dapsone led to significant improvement after two injections. Five months later, she relapsed. It was then decided to reduce the interval between injections to once a week. Rapid improvement was achieved in one month allowing resumption of the original frequency of the injection without relapse after 20 months of follow-up. In conclusion, our cases confirm the previously reported efficacy of anti-TNFα in resistant SPD. They also highlight a risk of secondary loss of efficacy, reinforced by the literature data. Substitution of another TNFα blocker or shortening of interval between injections provided a renewal in response to treatment.
Collapse
Affiliation(s)
- Clemence Guerin
- Dermatology, Centre Hospitalier Universitaire de Poitiers, Poitiers, FRA
| | - Marie Beylot-Barry
- Dermatology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, FRA
| | - Eric Frouin
- Pathology, Centre Hospitalier Universitaire de Poitiers, Poitiers, FRA
| | - Ewa Hainaut
- Dermatology, Centre Hospitalier Universitaire de Poitiers, Poitiers, FRA
| | | |
Collapse
|
4
|
Sellam J, Morel J, Tournadre A, Bouhnik Y, Cornec D, Devauchelle-Pensec V, Dieudé P, Goupille P, Jullien D, Kluger N, Lazaro E, Le Goff B, de Lédinghen V, Lequerré T, Nocturne G, Seror R, Truchetet ME, Verhoeven F, Pham T, Richez C. PRACTICAL MANAGEMENT of patients on anti-TNF therapy: Practical guidelines drawn up by the Club Rhumatismes et Inflammation (CRI). Joint Bone Spine 2021; 88:105174. [PMID: 33992225 DOI: 10.1016/j.jbspin.2021.105174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jérémie Sellam
- Service de Rhumatologie, CHU Saint-Antoine, Paris, France
| | - Jacques Morel
- Service de Rhumatologie, CHU Montpellier, Montpellier, France
| | - Anne Tournadre
- Service de Rhumatologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Yoram Bouhnik
- Service de Gastro-entérologie, CHU Hôpital Beaujon, Clichy, France
| | - Divi Cornec
- Service de Rhumatologie, CHRU La Cavale Blanche, Brest, France
| | | | - Philippe Dieudé
- Service de Rhumatologie, CHU Bichat-Claude Bernard, Paris, France
| | | | | | - Nicolas Kluger
- Dpt Dermatology, Helsinki, Finland; Service de Dermatologie, CHU Bichat-Claude Bernard, Paris, France
| | - Estibaliz Lazaro
- Service de Médecine interne, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | - Victor de Lédinghen
- Unité d'Hépatologie et transplantation hépatique, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | | | - Raphaèle Seror
- Service de Rhumatologie, Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | - Thao Pham
- Service de Rhumatologie, CHU Sainte-Marguerite, Marseille, France
| | | |
Collapse
|
5
|
Lemieux-Blanchard É. Monoclonal gammopathy of undetermined significance and biological treatments: What should we do? Joint Bone Spine 2017; 84:651-653. [PMID: 28412476 DOI: 10.1016/j.jbspin.2017.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Émilie Lemieux-Blanchard
- Service d'hématologie-oncologie du Centre hospitalier de l'université de Montréal and Centre de recherche du CHUM, hôpital Notre-Dame, 1560, rue Sherbrooke-E., Montréal (Québec), H2L 4M1, Canada.
| |
Collapse
|
6
|
Conti A, Esposito I, Lasagni C, Miglietta R, Padalino C, Fabiano A, Pellacani G. Monoclonal Gammopathy of Undetermined Significance in Patients with Psoriasis: Is it Really a Side Effect of Biological Therapy? Drug Dev Res 2014; 75 Suppl 1:S35-7. [DOI: 10.1002/ddr.21191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Andrea Conti
- Dermatology Unit; Department of Head and Neck Surgery; Azienda Ospedaliero Universitaria Policlinico di Modena; Modena Italy
| | - Ilaria Esposito
- Dermatology Unit; Department of Head and Neck Surgery; Azienda Ospedaliero Universitaria Policlinico di Modena; Modena Italy
| | - Claudia Lasagni
- Dermatology Unit; Department of Head and Neck Surgery; Azienda Ospedaliero Universitaria Policlinico di Modena; Modena Italy
| | - Roberta Miglietta
- Dermatology Unit; Department of Head and Neck Surgery; Azienda Ospedaliero Universitaria Policlinico di Modena; Modena Italy
| | - Claudia Padalino
- Dermatology Unit; Department of Head and Neck Surgery; Azienda Ospedaliero Universitaria Policlinico di Modena; Modena Italy
| | - Antonella Fabiano
- Dermatology Unit; Department of Head and Neck Surgery; Azienda Ospedaliero Universitaria Policlinico di Modena; Modena Italy
| | - Giovanni Pellacani
- Dermatology Unit; Department of Head and Neck Surgery; Azienda Ospedaliero Universitaria Policlinico di Modena; Modena Italy
| |
Collapse
|
7
|
Di Lernia V, Ficarelli E, Lallas A, Possemato N, Chiarolanza I, Salvarani C. Frequency of monoclonal gammopathy in psoriatic patients receiving anti-TNF therapy compared with patients taking conventional drugs: a cross-sectional study. J Eur Acad Dermatol Venereol 2014; 29:2262-3. [PMID: 24911670 DOI: 10.1111/jdv.12565] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- V Di Lernia
- Department of Dermatology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - E Ficarelli
- Department of Dermatology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - A Lallas
- Department of Dermatology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - N Possemato
- Rheumatology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - I Chiarolanza
- Rheumatology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - C Salvarani
- Rheumatology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| |
Collapse
|
8
|
Mielnik P, Hjelle AM, Szatkowski D. Monoclonal gammopathy of undetermined significance and anti-TNF-α treatment: comments on the article by Smale and Lawson. Scand J Rheumatol 2013; 42:335-6. [DOI: 10.3109/03009742.2013.798030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
9
|
Le diagnostic de « MGUS » est-il sous-estimé dans le traitement du psoriasis par anti-tnf α ? Ann Dermatol Venereol 2013; 140:157-8. [DOI: 10.1016/j.annder.2012.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
10
|
Shareef MS, Munro LR, Owen RG, Highet AS. Progression of IgA gammopathy to myeloma following infliximab treatment for pyoderma gangrenosum. Clin Exp Dermatol 2011; 37:146-8. [PMID: 22103549 DOI: 10.1111/j.1365-2230.2011.04219.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pyoderma gangrenosum (PG) may be associated with inflammatory disorders and haematological conditions such as monoclonal gammopathy of uncertain significance (MGUS). We report the case of a 53-year old man who had PG and MGUS. After treatment with infliximab for the PG, he developed myeloma. The course of events in this case suggests that infliximab facilitated the progression from MGUS to myeloma.
Collapse
Affiliation(s)
- M S Shareef
- Department of Dermatology, York Teaching Hospital, York, UK.
| | | | | | | |
Collapse
|
11
|
Pham T, Bachelez H, Berthelot JM, Blacher J, Bouhnik Y, Claudepierre P, Constantin A, Fautrel B, Gaudin P, Goëb V, Gossec L, Goupille P, Guillaume-Czitrom S, Hachulla E, Huet I, Jullien D, Launay O, Lemann M, Maillefert JF, Marolleau JP, Martinez V, Masson C, Morel J, Mouthon L, Pol S, Puéchal X, Richette P, Saraux A, Schaeverbeke T, Soubrier M, Sudre A, Tran TA, Viguier M, Vittecoq O, Wendling D, Mariette X, Sibilia J. TNF alpha antagonist therapy and safety monitoring. Joint Bone Spine 2011; 78 Suppl 1:15-185. [PMID: 21703545 DOI: 10.1016/s1297-319x(11)70001-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To develop and/or update fact sheets about TNFα antagonists treatments, in order to assist physicians in the management of patients with inflammatory joint disease. METHODS 1. selection by a committee of rheumatology experts of the main topics of interest for which fact sheets were desirable; 2. identification and review of publications relevant to each topic; 3. development and/or update of fact sheets based on three levels of evidence: evidence-based medicine, official recommendations, and expert opinion. The experts were rheumatologists and invited specialists in other fields, and they had extensive experience with the management of chronic inflammatory diseases, such as rheumatoid. They were members of the CRI (Club Rhumatismes et Inflammation), a section of the Société Francaise de Rhumatologie. Each fact sheet was revised by several experts and the overall process was coordinated by three experts. RESULTS Several topics of major interest were selected: contraindications of TNFα antagonists treatments, the management of adverse effects and concomitant diseases that may develop during these therapies, and the management of everyday situations such as pregnancy, surgery, and immunizations. After a review of the literature and discussions among experts, a consensus was developed about the content of the fact sheets presented here. These fact sheets focus on several points: 1. in RA and SpA, initiation and monitoring of TNFα antagonists treatments, management of patients with specific past histories, and specific clinical situations such as pregnancy; 2. diseases other than RA, such as juvenile idiopathic arthritis; 3. models of letters for informing the rheumatologist and general practitioner; 4. and patient information. CONCLUSION These TNFα antagonists treatments fact sheets built on evidence-based medicine and expert opinion will serve as a practical tool for assisting physicians who manage patients on these therapies. They will be available continuously at www.cri-net.com and updated at appropriate intervals.
Collapse
Affiliation(s)
- Thao Pham
- Rheumatology Department, CHU Sainte-Marguerite, Marseille, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Prignano F, Pescitelli L, Ricceri F, Ermini A, Lotti T. Development of MGUS in psoriatic patients: a possible undiagnosed event during anti-TNF-α-treatment. J Eur Acad Dermatol Venereol 2011; 26:1444-8. [PMID: 21834947 DOI: 10.1111/j.1468-3083.2011.04216.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Monoclonal gammopathies are haematological conditions characterized by the clonal proliferation of plasma cells which produce a monoclonal immunoglobulin that accumulates in the blood. They have already been reported during treatment with a range of drugs but never before during treatment with the anti-TNF-α treatments: adalimumab, etanercept and infliximab currently used in the therapy of moderate-severe psoriasis and psoriatic arthritis. OBJECTIVE This is a case series describing the development of MGUS in psoriatic patients treated with anti-TNF-α. METHODS Three hundred patients receiving an anti-TNF-α treatment for chronic plaque psoriasis or psoriatic arthritis in a clinical setting in Italy, These patients were screened through serum protein electrophoresis to investigate the possible development of MGUS. RESULTS Eight patients were found to have developed monoclonal gammopathy of undetermined significance. The median treatment duration for the eight patients was 1 year with excessive IgG present in five patients, IgM accumulation in one patient and a double monoclonal component in two patients. CONCLUSION Our data suggest that there may be an association between anti-TNF-α therapy and development of MGUS.
Collapse
Affiliation(s)
- F Prignano
- Department of Dermatological Sciences, Florence University, Santa Maria Annunziata Hospital, Florence, Italy.
| | | | | | | | | |
Collapse
|
13
|
Matsuyama Y, Nagashima T, Honne K, Kamata Y, Iwamoto M, Okazaki H, Sato K, Ozawa K, Minota S. Successful treatment of a patient with rheumatoid arthritis and IgA-κ multiple myeloma with tocilizumab. Intern Med 2011; 50:639-42. [PMID: 21422694 DOI: 10.2169/internalmedicine.50.4636] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 63-year-old woman receiving tumor necrosis factor (TNF) inhibitors for rheumatoid arthritis (RA) was found to have smoldering IgA-kappa type multiple myeloma (MM). Retrospective examination of stored serum samples revealed a steady increase of serum IgA levels after the start of TNF inhibitor therapy. The patient's articular symptoms showed marked exacerbation when TNF inhibitors were discontinued because of fear of worsening the MM. Tocilizumab improved RA symptoms dramatically and stabilized serum IgA levels for 13 months after a transient steep rise. This case suggests that tocilizumab can be used safely in patients with inflammatory disorders with coexisting MM.
Collapse
Affiliation(s)
- Yasushi Matsuyama
- Division of Rheumatology and Clinical Immunology, Jichi Medical University, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Terapias anti-TNF y neoplasias. ACTA ACUST UNITED AC 2010; 6:102-5. [DOI: 10.1016/j.reuma.2009.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 01/15/2009] [Accepted: 01/15/2009] [Indexed: 12/17/2022]
|
15
|
Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [PMID: 18533281 PMCID: PMC7167700 DOI: 10.1002/pds.1487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of pharmacoepidemiology and drug safety. Each bibliography is divided into 20 sections: 1 Reviews; 2 General; 3 Anti‐infective Agents; 4 Cardiovascular System Agents; 5 CNS Depressive Agents; 6 Non‐steroidal Anti‐inflammatory Agents; 7 CNS Agents; 8 Anti‐neoplastic Agents; 9 Haematological Agents; 10 Neuroregulator‐Blocking Agents; 11 Dermatological Agents; 12 Immunosuppressive Agents; 13 Autonomic Agents; 14 Respiratory System Agents; 15 Neuromuscular Agents; 16 Reproductive System Agents; 17 Gastrointestinal System Agents; 18 Anti‐inflammatory Agents ‐ Steroidal; 19 Teratogens/fetal exposure; 20 Others. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.
Collapse
|