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Wang QA, Chan TM. Case report: Management of Epstein-Barr virus positive and methotrexate-associated B-cell lymphoma. Int J Rheum Dis 2024; 27:e15086. [PMID: 38443759 DOI: 10.1111/1756-185x.15086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/26/2024] [Accepted: 02/02/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Qi-An Wang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tien-Ming Chan
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Spadaro JZ, Perzia B, Perincheri S, Habib L. A Rare Case of Methotrexate-Associated Lymphoproliferative Disease in the Orbit. Ophthalmic Plast Reconstr Surg 2024; 40:e28-e31. [PMID: 37791841 DOI: 10.1097/iop.0000000000002528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
An 80-year-old Caucasian female with a history of rheumatoid arthritis presented with a 6-month history of progressive right upper eyelid ptosis, edema, erythema, and pain. MRI demonstrated a superior orbital mass. An incisional biopsy was performed, and pathologic analysis revealed an atypical lymphoid infiltrate, co-expressing both B and T-cell markers, with a low proliferation rate. Flow cytometry and IgH rearrangement study did not demonstrate any B- or T-cell monoclonal proliferation. Based on these findings, she was diagnosed with an iatrogenic immunodeficiency-associated lymphoproliferative disorder. Discontinuation of methotrexate resulted in the complete resolution of her symptoms, and she remains in remission 18 months later. Given the increased risk of lymphoproliferative disease in patients with rheumatoid arthritis, careful evaluation and close monitoring upon immunosuppressive medication withdrawal is necessary to confirm the diagnosis.
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Affiliation(s)
- Jane Z Spadaro
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, Connecticut, U.S.A
- Kahana Oculoplastic and Orbital Surgery, Michigan, U.S.A
| | - Brittany Perzia
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, Connecticut, U.S.A
| | - Sudhir Perincheri
- Department of Pathology, Yale University School of Medicine, Connecticut, U.S.A
| | - Larissa Habib
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, Connecticut, U.S.A
- Northeast Ophthalmic Plastic and Reconstructive Surgery, Connecticut, U.S.A
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Atsumi T, Tanaka Y, Matsubara T, Amano K, Ishiguro N, Sugiyama E, Yamaoka K, Westhovens R, Ching DWT, Messina OD, Burmester GR, Bartok B, Pechonkina A, Kondo A, Yin Z, Guo Y, Tasset C, Sundy JS, Takeuchi T. Efficacy and safety of filgotinib alone and in combination with methotrexate in Japanese patients with active rheumatoid arthritis and limited or no prior exposure to methotrexate: Subpopulation analyses of 24-week data of a global phase 3 study (FINCH 3). Mod Rheumatol 2021; 32:273-283. [PMID: 34910203 DOI: 10.1093/mr/roab021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/21/2021] [Accepted: 06/04/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of filgotinib for Japanese patients with rheumatoid arthritis (RA) and limited or no prior methotrexate (MTX) exposure. METHODS Data up to 24 weeks were analysed for 71 Japanese patients from a 52-week global Phase 3 study. Patients with RA and limited or no prior MTX exposure were randomised in a 2:1:1:2 ratio to filgotinib 200 mg plus MTX, filgotinib 100 mg plus MTX, filgotinib 200 mg, or MTX. Maximum MTX dose was 15 mg/week. Primary endpoint was proportion achieving 20% improvement in American College of Rheumatology criteria (ACR20) at Week 24. RESULTS Week 24 ACR20 rates in Japanese patients were 82.6%, 90.9%, 83.3%, and 80.0% for filgotinib 200 mg plus MTX, filgotinib 100 mg plus MTX, filgotinib 200 mg, and MTX, respectively. Greater ACR20 rates with filgotinib vs MTX occurred at Week 2. Greater proportions receiving filgotinib vs MTX achieved DAS28-CRP <2.6 at Weeks 12 and 24. Adverse event rates were comparable across treatments and between the Japanese and overall populations. CONCLUSIONS While Week 24 ACR20 rates were similar, filgotinib provided faster responses and higher remission rates vs MTX. In Japanese patients with RA and limited or no prior MTX exposure, filgotinib was generally well tolerated.
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Affiliation(s)
- Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Tsukasa Matsubara
- Department of Orthopedics, Matsubara Mayflower Hospital, 944-25 Fujita, Kato, Japan
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Hidaka, Japan
| | | | - Eiji Sugiyama
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kunihiro Yamaoka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Japan
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Division of Rheumatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Daniel W T Ching
- Timaru Medical Specialists Limited, South Canterbury, New Zealand
| | | | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Free University and Humboldt University, Berlin, Germany
| | | | | | | | - Zhaoyu Yin
- Gilead Sciences Inc., Foster City, CA, USA
| | - Ying Guo
- Gilead Sciences Inc., Foster City, CA, USA
| | | | - John S Sundy
- Gilead Sciences Inc., Foster City, CA, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Aichi Developmental Disability Center, Kasugai, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Nakano K, Tanaka Y, Saito K, Kaneko Y, Saito S, Tanaka M, Saito R, Fujii T, Kuramoto N, Sugimoto N, Takada H, Harigai M, Sasaki S, Suzuki Y. Treatment of rheumatoid arthritis after regression of lymphoproliferative disorders in patients treated with methotrexate: a retrospective, multi-center descriptive study. Mod Rheumatol 2020; 32:41-49. [PMID: 33164614 DOI: 10.1080/14397595.2020.1847775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
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.
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Affiliation(s)
- Kazuhisa Nakano
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.,Working Group on the Rheumatoid Arthritis-associated Lymphoproliferative Disorders of the Japan College of Rheumatology, Tokyo, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazuyoshi Saito
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.,Working Group on the Rheumatoid Arthritis-associated Lymphoproliferative Disorders of the Japan College of Rheumatology, Tokyo, Japan.,Tobata General Hospital, Kitakyushu, Japan
| | - Yuko Kaneko
- Working Group on the Rheumatoid Arthritis-associated Lymphoproliferative Disorders of the Japan College of Rheumatology, Tokyo, Japan.,Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shuntaro Saito
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masao Tanaka
- Working Group on the Rheumatoid Arthritis-associated Lymphoproliferative Disorders of the Japan College of Rheumatology, Tokyo, Japan.,Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Rintaro Saito
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takao Fujii
- Working Group on the Rheumatoid Arthritis-associated Lymphoproliferative Disorders of the Japan College of Rheumatology, Tokyo, Japan.,Department of Rheumatology and Clinical Immunology, Wakayama Medical University, Wakayama, Japan
| | - Nobuo Kuramoto
- Department of Rheumatology and Clinical Immunology, Wakayama Medical University, Wakayama, Japan
| | - Naoki Sugimoto
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hideto Takada
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Masayoshi Harigai
- Working Group on the Rheumatoid Arthritis-associated Lymphoproliferative Disorders of the Japan College of Rheumatology, Tokyo, Japan.,Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Sho Sasaki
- Division of Rheumatology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Yasuo Suzuki
- Working Group on the Rheumatoid Arthritis-associated Lymphoproliferative Disorders of the Japan College of Rheumatology, Tokyo, Japan.,Division of Rheumatology, Tokai University Hachioji Hospital, Tokyo, Japan
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