TNFα antagonist therapy does not increase the Epstein-Barr virus burden in patients with rheumatoid arthritis or ankylosing spondylitis

Couderc, Marion; Payet, Sarah; Henquell, Cécile; Dubost, Jean‐Jacques; Soubrier, Martin

doi:10.1016/j.jbspin.2010.04.014

Cited by 10 publications

(2 citation statements)

References 26 publications

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“…Multiple large population‐ and registry‐based RA studies from the United Kingdom, Sweden, Denmark and the United States found no increased lymphoma risk in patients receiving TNFi compared with conventional DMARDs 29 . Several studies have examined the effect of TNFi on EBV burden in RA patients and found no increase in EBV load or re‐activation 30–32 . Similarly, the effect of tocilizumab and abatacept on peripheral blood mononuclear cell EBV load has been studied.…”

Section: Discussionmentioning

confidence: 99%

Epstein–Barr virus‐related lymphoma in rheumatoid arthritis: implications for long‐term usage of immunosuppressive drugs and review of the literature

Williamson

Cai

et al. 2022

Internal Medicine Journal

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Background Rheumatoid arthritis (RA) is a common autoimmune disease where methotrexate (MTX) is widely used as the first‐line therapy. The combination of RA and MTX is associated with lymphoproliferative disorders (LPD). RA patients with Epstein–Barr virus (EBV) have impaired T‐lymphocyte function, thus allowing an overgrowth of EBV‐positive lymphoblastoid cells. We examined the association of EBV with LPD in immunosuppressed RA patients, particularly those treated with MTX. Aim To review the relationship between RA, EBV‐associated LPD and MTX use. Methods We reported two cases of RA patients with long‐term MTX treatment who subsequently developed EBV‐positive LPD, followed by a review of the relevant literature. Results Compared with normal population, RA patients have a higher risk of lymphoma, with diffuse large B‐cell lymphoma being the most common subtype. MTX withdrawal can lead to lymphoma regression. Other biological therapies, such as abatacept and tocilizumab, are not associated with increased EBV‐positive lymphoma diagnosis in RA patients. Conclusion The association between EBV, lymphoma and MTX highlights the need to consider reducing or stopping MTX in patients who have had stable RA for many years.

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Section: Discussionmentioning

confidence: 99%

Epstein–Barr virus‐related lymphoma in rheumatoid arthritis: implications for long‐term usage of immunosuppressive drugs and review of the literature

Williamson

Cai

et al. 2022

Internal Medicine Journal

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“…While an EBV viral load above 500 copies per 500 ng determines an association of EBV reactivation with the LPD [17], the patients with RA tend to have viral loads that are around 10-fold higher than those patients without the disease [18]. e use of anti-TNF therapy by itself is not associated with an increased EBV load [19,20]. erefore, the kinetics of the EBV viral load has a better predictive value for the diagnosis of EBV-associated LPDs when the PBMC EBV viral load is monitored, namely in patients who are allograft or hematopoietic stem cell transplant (HSCT) recipients [21].…”

Section: Discussionmentioning

confidence: 99%

Reactivation of Epstein–Barr Virus Presenting as Massive Splenomegaly after Initiation of Golimumab Treatment

Febres-Aldana

Febres‐Aldana

Dvir

et al. 2020

Case Reports in Hematology

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Epstein–Barr virus infection is most commonly asymptomatic in the acute setting, where the end result of infection is the adoption of a viral latency phenotype. The virus can reactivate later in life leading to the abnormal proliferation of the infected B, T, or NK cells. Hereby, we report a 71-year-old female with seronegative rheumatoid arthritis who presented with massive splenomegaly, pancytopenia, and positivization of antibodies against double-stranded deoxyribonucleic acid (dsDNA) after initiation of the anti-tumor necrosis factor (TNF) golimumab. The diagnosis of EBV-associated lymphoproliferative disorder (LPD) was demonstrated by elevation of the plasmatic EBV viral load. Withdrawal of the anti-TNF and treatment with the anti-CD20 antibody rituximab were able to revert the clinical abnormalities. EBV-associated LPDs are described after initiation of other anti-TNF agents, such as infliximab, but no reports of golimumab-associated EBV LPD are found in the literature. The mechanisms for this occurrence are not clear, but these are known to involve expression of a panel of viral proteins specific to the viral latency phenotypes.

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Angioimmunoblastic T cell lymphoma in an ankylosing spondylitis patient treated with etanercept

et al. 2012

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Angioimmunoblastic T cell lymphoma (AITL) is a rare non-Hodgkin lymphoma that presents with profound immune dysfunction and immunodeficiency. The clinical and laboratory findings associated with AITL are similar to those of rheumatic disease, and AITL has been reported to be concurrent in patients with several rheumatic diseases. We present one case of AITL occurring in a patient with ankylosing spondylitis (AS) after treatment with etanercept. Constitutional symptoms and aggravation of peripheral arthritis in elderly AS patients may be due not only to flare-ups of AS but also to other complicating diseases, such as lymphoma. Although the occurrence of lymphoma in AS patients treated with etanercept has only rarely been reported, clinicians should keep in mind that instances of aggravation of peripheral arthritis in elderly AS patients occurring after immunosuppressant treatment may be due to other complicating systemic diseases such as AITL, rather than the rheumatic disease itself. Further study is needed in order to investigate whether or not using a TNF-α blocker such as etanercept increases the risk of lymphoma, especially for cases associated with Epstein-Barr virus.

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TNFα antagonist therapy does not increase the Epstein-Barr virus burden in patients with rheumatoid arthritis or ankylosing spondylitis

Cited by 10 publications

References 26 publications

Epstein–Barr virus‐related lymphoma in rheumatoid arthritis: implications for long‐term usage of immunosuppressive drugs and review of the literature

Epstein–Barr virus‐related lymphoma in rheumatoid arthritis: implications for long‐term usage of immunosuppressive drugs and review of the literature

Reactivation of Epstein–Barr Virus Presenting as Massive Splenomegaly after Initiation of Golimumab Treatment

Angioimmunoblastic T cell lymphoma in an ankylosing spondylitis patient treated with etanercept

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