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Master Thesis

Devenir des gammapathies monoclonales sous inhibiteurs de JAK

Abstract : Objective: monoclonal Gammopathy of Undetermined Significance (MGUS) is common in our patients with inflammatory rheumatic diseases, but literature data are scarce concerning the effect of our rheumatological therapies on these pre-malignant condition. The aim of this study was to investigate the evolution of MGUS under JAK inhibitors (JAKi). Methods: we conducted a retrospective observational study initially monocentric and then we launched a call for observations through both french national network Club Rhumatismes et Inflammations and investigators of the MAJIK registry. All patients treated with JAK inhibitors for an active rheumatic disease with monoclonal abnormality prior to JAKi initiation, both serum monoclonal protein or abnormal immunoglobulin detected in immunofixation without spike at serum protein electrophoresis, were eligible Results: 14 patients were identified, 8 women and 6 men, with a mean age of 65 years. The majority of patients (n=10/14) had rheumatoid arthritis, 2 patients had spondyloarthritis and 2 others had psoriatic arthritis. The JAKi prescribed was baricitinib (n=7), tofacitinib (n=4), or upadacitinib (n=3), and 2 patients had received multiple JAKi. The mean duration of treatment was 12 months. 12 patients had individualized serum monoclonal protein (IgG Kappa n=6; IgG Lambda n=3; IgM Kappa n=2; IgA Lambda n=1) ranging from 0,16g/dL to 2,3g/dL. With a follow-up ranging from 2 to 23 months, 6 of 12 patients experienced a decrease in serum monoclonal protein level and six had a stable serum monoclonal protein level. Moreover, 2 patients had no integrable peak but a positive IgG Lambda immunofixation which became negative for both patients. Conclusion: treatment with JAKi could be an interesting therapeutic option for our patients with inflammatory rheumatism and MGUS.
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Submitted on : Thursday, December 2, 2021 - 9:25:17 AM
Last modification on : Friday, December 17, 2021 - 3:47:07 AM
Long-term archiving on: : Thursday, March 3, 2022 - 6:39:55 PM

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Déborah Faganello. Devenir des gammapathies monoclonales sous inhibiteurs de JAK. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03462770⟩

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