Evolution of monoclonal gammopathy of undetermined significance in patients treated with JAK inhibitors for rheumatic diseases : data from the MAJIK-SFR registry
© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissionsoup.com..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:63 |
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| Enthalten in: |
Rheumatology (Oxford, England) - 63(2024), 3 vom: 01. März, Seite 787-790 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Faganello, Déborah [VerfasserIn] |
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| Links: |
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| Themen: |
Antibodies, Monoclonal |
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| Anmerkungen: |
Date Completed 04.03.2024 Date Revised 04.03.2024 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/rheumatology/kead187 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Evolution of monoclonal gammopathy of undetermined significance in patients treated with JAK inhibitors for rheumatic diseases |b data from the MAJIK-SFR registry |
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| 500 | |a Date Revised 04.03.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissionsoup.com. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a JAK inhibitors | |
| 650 | 4 | |a RA | |
| 650 | 4 | |a monoclonal gammopathy of undetermined significance | |
| 650 | 4 | |a myeloma | |
| 650 | 4 | |a rheumatic diseases | |
| 650 | 7 | |a Janus Kinase Inhibitors |2 NLM | |
| 650 | 7 | |a Antibodies, Monoclonal |2 NLM | |
| 650 | 7 | |a Immunoglobulin G |2 NLM | |
| 700 | 1 | |a Bertrand, Anne |e verfasserin |4 aut | |
| 700 | 1 | |a Meunier, Pauline |e verfasserin |4 aut | |
| 700 | 1 | |a Avouac, Jérôme |e verfasserin |4 aut | |
| 700 | 1 | |a Toussirot, Eric |e verfasserin |4 aut | |
| 700 | 1 | |a Coury, Fabienne |e verfasserin |4 aut | |
| 700 | 1 | |a Seror, Raphaele |e verfasserin |4 aut | |
| 700 | 1 | |a Le Mélédo, Guillaume |e verfasserin |4 aut | |
| 700 | 1 | |a Germain, Vincent |e verfasserin |4 aut | |
| 700 | 1 | |a Dellal, Azedinne |e verfasserin |4 aut | |
| 700 | 1 | |a Shima, Ditmar |e verfasserin |4 aut | |
| 700 | 1 | |a Hulin, Cyrille |e verfasserin |4 aut | |
| 700 | 1 | |a Prati, Clément |e verfasserin |4 aut | |
| 700 | 1 | |a Schaeverbeke, Thierry |e verfasserin |4 aut | |
| 700 | 1 | |a Richez, Christophe |e verfasserin |4 aut | |
| 700 | 1 | |a Truchetet, Marie-Elise |e verfasserin |4 aut | |
| 700 | 1 | |a Kostine, Marie |e verfasserin |4 aut | |
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