Methotrexate Dose May Associated with the Frequency of Lymphoproliferative Disorders in Rheumatoid Arthritis

Hiroaki Dobashi¹, Tomohiro Kameda¹, Masayuki Inoo², Ikuko Onishi², Noriyuki Kurata², Miharu Izumikawa¹, Yohei Takeuchi³, Shusaku Nakashima¹, Hiromi Shimada¹, Hiroki Ozaki¹, Risa Wakiya¹ and Norimitsu Kadowaki⁴, ¹Internal Medicine Division of Hematology, Rheumatology, and Respiratory Medicine, Kagawa University, Kagawa, Japan, ²Utazu hospital, Kagawa, Japan, ³Internal Medicine Division of Endocrinology and Metabolism, Hematology, Rheumatology and Respiratory Medicine, Kagawa University, Kagawa, Japan, ⁴Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University,, Kagawa, Japan

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: methotrexate (MTX) and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, November 10, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster Session III

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

Rheumatoid arthritis (RA) is a systemic inflammatory disease that is characterized by synovitis and the destruction of articular structures of multiple joints. The goal of treatment for RA is to control the progression of these articular lesions. MTX is an antirheumatic drug that is expected to have an excellent suppressive effect on articular destruction. Recently, MTX has been used as an anchor drug for the treatment of RA (1). On the other hand, RA patients have a high risk of onset of lymphoproliferative disorders (LPD) (2). Although MTX-LPD occurs mainly in RA patients, it has not been established if MTX administration is an independent risk factor for LPD in RA patients.

We examined the clinical characteristics of MTX-LPD in Japanese RA patients and attempted to determine the risk factors for MTX-LPD development.

Methods: We performed a nested case-control study on RA patients. We enrolled 5,873 RA patients from Kagawa Prefecture, Japan between June 2003 and May 2015. Patients were diagnosed according to American College of Rheumatology 1987 classification criteria, and treated with disease modifying antirheumatic drugs (DMARDs) including MTX. In age and gender matched patients, we separated patients who did not develop LPD under MTX treatment (MTX non-LPD group) from those that did (MTX-LPD group), and conducted a comparative examination. We used multivariate analysis to determine the independent risk factors for MTX-LPD onset.

Results:

There were 36 patients in the MTX-LPD group and 158 patients in the MTX non-LPD group. The number of patients with DMARDs (except MTX) treatment showed no significant difference in two groups. Furthermore, there was no difference between two groups about that with corticosteroid and biologics treatment. Also, the complication rates for Sjögren’s syndrome did not differ significantly. Using univariate analysis, significant differences were found in the duration of RA disease, total MTX dose and mean MTX dose between the two groups. Furthermore, multivariate analysis of the parameters extracted by univariate analysis revealed that the mean MTX dose was a risk factor for MTX-LPD after adjusting for age.

Conclusion:

We revealed the mean MTX dose was demonstrated to be an independent risk factor regarding MTX-LPD onset in RA patients. This data strongly suggest that the treatment with higher MTX dose promotes LPD onset in Japanese RA patients.

Disclosure: H. Dobashi, None; T. Kameda, None; M. Inoo, None; I. Onishi, None; N. Kurata, None; M. Izumikawa, None; Y. Takeuchi, None; S. Nakashima, None; H. Shimada, None; H. Ozaki, None; R. Wakiya, None; N. Kadowaki, None.

To cite this abstract in AMA style:

Dobashi H, Kameda T, Inoo M, Onishi I, Kurata N, Izumikawa M, Takeuchi Y, Nakashima S, Shimada H, Ozaki H, Wakiya R, Kadowaki N. Methotrexate Dose May Associated with the Frequency of Lymphoproliferative Disorders in Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/methotrexate-dose-may-associated-with-the-frequency-of-lymphoproliferative-disorders-in-rheumatoid-arthritis/. Accessed .

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