Methotrexate treatment for rheumatoid arthritis and potentially reversible lymphomas: an indication for alternative anti-rheumatic therapy

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Thomas Patrick C Covello
Farah Yasin Moid
Jerry Mathew Maniate

Keywords

rheumatoid arthritis, methotrexate, biologic response modifiers, lymphoma, Hodgkin lymphoma

Abstract

Rheumatoid arthritis and methotrexate treatment are associated with the development of lymphoma. Some of these lymphomas may show partial or complete regression with withdrawal from methotrexate. While the possibility of regression is not an indication to forgo conventional treatment for lymphoma, it is an indication to seek alternative anti-rheumatic drugs for patients with both conditions. Rituximab is both part of the standard chemotherapy for B-cell non-Hodgkin lymphomas and approved for rheumatoid arthritis. However, in other lymphomas and in patients not on chemotherapy, practitioners must add another agent to replace methotrexate. Among the most commonly used biologics for rheumatoid arthritis, etanercept was not associated with an increased risk of lymphoma development, whereas infliximab and adalimumab were associated with an approximate fourfold increase in risk. Hence it is hypothesized that switching lymphoma patients from methotrexate to rituximab or etanercept may decrease the risk of progression.