Umekita Kunihiko, Umeki Kazumi, Miyauchi Shunichi, Ueno Shiro, Kubo Kazuyoshi, Kusumoto Norio, Takajo Ichiro, Nagatomo Yasuhiro, Okayama Akihiko
a Division of Rheumatology, Infectious Diseases and Laboratory Medicine, Department of Internal Medicine , Faculty of Medicine, University of Miyazaki , Miyazaki , Japan.
Mod Rheumatol. 2015 Sep;25(5):794-7. doi: 10.3109/14397595.2013.844389. Epub 2015 Jul 29.
Anti-tumor necrosis factor (anti-TNF) biologics are effective in the treatment of rheumatoid arthritis (RA); however, it is still not clear whether this treatment promotes the development of malignancies such as lymphoma. Human T-lymphotropic virus type 1 (HTLV-1), which is a causative agent of adult T-cell lymphoma (ATL), is prevalent in Japan. Many HTLV-1-positive patients with RA are assumed to exist; however, there have thus far been no reports on the effect of anti-TNF biologics on HTLV-1-positive patients. We analyzed the response to treatment with anti-TNF biologics and change of HTLV-1 markers in two cases of RA. The two cases showed no response based on the European League Against of Rheumatism response criteria 60-96 weeks after administration of anti-TNF biologics (infliximab and etanercept). No signs of ATL were observed and HTLV-1 markers, such as proviral load and clonality of HTLV-1-infected cells, showed no significant change in either of two cases. Therefore, treatment with anti-TNF biologics did not induce activation of HTLV-1, although the effect on RA was not as effective as in HTLV-1-negative patients in this limited study. Further long-term study with a greater number of patients is necessary to clarify the safety and efficacy of anti-TNF biologics in HTLV-1-positive patients with RA.
抗肿瘤坏死因子（抗TNF）生物制剂在类风湿关节炎（RA）的治疗中有效；然而，这种治疗是否会促进淋巴瘤等恶性肿瘤的发展仍不清楚。1型人类嗜T淋巴细胞病毒（HTLV-1）是成人T细胞淋巴瘤（ATL）的病原体，在日本很普遍。据推测存在许多HTLV-1阳性的RA患者；然而，迄今为止尚无关于抗TNF生物制剂对HTLV-1阳性患者影响的报道。我们分析了2例RA患者对抗TNF生物制剂治疗的反应以及HTLV-1标志物的变化。在使用抗TNF生物制剂（英夫利昔单抗和依那西普）给药60 - 96周后，根据欧洲抗风湿病联盟反应标准，这2例患者均无反应。未观察到ATL的迹象，并且HTLV-1标志物，如前病毒载量和HTLV-1感染细胞的克隆性，在这2例患者中均未显示出显著变化。因此，在这项有限的研究中，尽管抗TNF生物制剂对RA的疗效不如在HTLV-1阴性患者中有效，但它并未诱导HTLV-1的激活。需要进行更多患者的进一步长期研究，以阐明抗TNF生物制剂在HTLV-1阳性RA患者中的安全性和疗效。
