Cutaneous Lymphoma Associated with JAK Inhibitors: A Pharmacovigilance Analysis of the FAERS Database and Literature Review
DOI:
https://doi.org/10.2340/actadv.v106.44546Keywords:
cutaneous lymphoma, JAK inhibitors, FAERS, pharmacovigilance studiesAbstract
The increasing use of JAK inhibitors in clinical practice is raising concerns regarding the potential risk of cutaneous lymphoma. This study aimed to conduct a comprehensive search for cases of cutaneous lymphoma associated with JAK inhibitors in the Food and Drug Administration’s Adverse Event Reporting System. The clinical characteristics of cases from January 2004 to September 2023 were retrieved from the FAERS database. Disproportionality and Bayesian analyses were performed to detect signals for cutaneous lymphoma associated with JAK inhibitors. In total, 24 cases of cutaneous lymphoma were identified associated with JAK inhibitors, including tofacitinib, ruxolitinib, baricitinib, upadacitinib, and abrocitinib. The majority of patients (64%) were aged 60 or older, with no significant difference in incidence between genders. The average onset time was 8.64 months. One patient with ruxolitinib experienced a fatal outcome, and 1 patient with tofacitinib had a life-threatening event. Cutaneous lymphoma associated with baricitinib has the highest reporting odds ratio (23.91, 95% confidence interval 10.71–53.4), proportional reporting ratio (23.88, χ2 = 103.67), information component (4.57, IC025 = 2.05), and empirical Bayes geometric mean (23.73, EBGM05 = 12.12). The occurrence of cutaneous lymphoma associated with JAK inhibitors highlights the importance of pharmacovigilance studies to deepen our understanding of both the medications and associated conditions.
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References
Willemze R, Cerroni L, Kempf W, Berti E, Facchetti F, Swerdlow SH, et al. The 2018 update of the WHO-EORTC classification for primary cutaneous lymphomas. Blood 2019; 133: 1703–1714. DOI: https://doi.org/10.1182/blood-2018-11-881268
Rubio-Gonzalez B, Zain J, Rosen ST, Querfeld C. Clinical manifestations and pathogenesis of cutaneous lymphomas: current status and future directions. Br J Haematol 2017; 176: 16–36. DOI: https://doi.org/10.1111/bjh.14402
Latzka J, Trautinger F. Mycosis fungoides and Sézary syndrome: review and outlook. J Dtsch Dermatol Ges 2023; 21: 386–391. DOI: https://doi.org/10.1111/ddg.15051
Hwang ST, Janik JE, Jaffe ES, Wilson WH. Mycosis fungoides and Sézary syndrome. Lancet 2008; 371: 945–957. DOI: https://doi.org/10.1016/S0140-6736(08)60420-1
Bastidas Torres AN, Cats D, Mei H, Szuhai K, Willemze R, Vermeer MH, et al. Genomic analysis reveals recurrent deletion of JAK-STAT signaling inhibitors HNRNPK and SOCS1 in mycosis fungoides. Genes Chromosomes Cancer 2018; 57: 653–664. DOI: https://doi.org/10.1002/gcc.22679
Koh J, Jang I, Mun S, Lee C, Cha HJ, Oh YH, et al. Genetic profiles of subcutaneous panniculitis-like T-cell lymphoma and clinicopathological impact of HAVCR2 mutations. Blood Adv 2021; 5: 3919–3930. DOI: https://doi.org/10.1182/bloodadvances.2021004562
Schiemann WP, Pfeifer WM, Levi E, Kadin ME, Lodish HF. A deletion in the gene for transforming growth factor beta type I receptor abolishes growth regulation by transforming growth factor beta in a cutaneous T-cell lymphoma. Blood 1999; 94: 2854–2861. DOI: https://doi.org/10.1182/blood.V94.8.2854.420k07_2854_2861
Namba H, Hamada T, Iwatsuki K. Human T-cell leukemia virus type 1-positive lymphomatoid papulosis. Eur J Dermatol 2016; 26: 194–195. DOI: https://doi.org/10.1684/ejd.2015.2707
Yonekura K. Current treatment strategies and emerging therapies for cutaneous lymphoma. J Dermatol 2022; 49: 223–231. DOI: https://doi.org/10.1111/1346-8138.16289
Hu X, Li J, Fu M, Zhao X, Wang W. The JAK/STAT signaling pathway: from bench to clinic. Signal Transduct Target Ther 2021; 6: 402. DOI: https://doi.org/10.1038/s41392-021-00791-1
Xue C, Yao Q, Gu X, Shi Q, Yuan X, Chu Q, et al. Evolving cognition of the JAK-STAT signaling pathway: autoimmune disorders and cancer. Signal Transduct Target Ther 2023; 8: 204. DOI: https://doi.org/10.1038/s41392-023-01468-7
Sakaeda T, Tamon A, Kadoyama K, Okuno Y. Data mining of the public version of the FDA Adverse Event Reporting System. Int J Med Sci 2013; 10: 796–803. DOI: https://doi.org/10.7150/ijms.6048
Vahabi SM, Bahramian S, Esmaeili F, Danaei B, Kalantari Y, Fazeli P, et al. JAK iInhibitors in cutaneous T-cell lymphoma: friend or foe? A systematic review of the published literature. Cancers 2024; 16: 861. DOI: https://doi.org/10.3390/cancers16050861
Ma J, Xing W, Coffey G, Dresser K, Lu K, Guo A, et al. Cerdulatinib, a novel dual SYK/JAK kinase inhibitor, has broad anti-tumor activity in both ABC and GCB types of diffuse large B cell lymphoma. Oncotarget 2015; 6: 43881–43896. DOI: https://doi.org/10.18632/oncotarget.6316
Hamlin PA, Flinn IW, Wagner-Johnston N, Burger JA, Coffey GP, Conley PB, et al. Efficacy and safety of the dual SYK/JAK inhibitor cerdulatinib in patients with relapsed or refractory B-cell malignancies: Results of a phase I study. Am J Hematol 2019; 94: E90–E93. DOI: https://doi.org/10.1002/ajh.25387
Pérez C, Mondéjar R, García-Díaz N, Cereceda L, León A, Montes S, et al. Advanced-stage mycosis fungoides: role of the signal transducer and activator of transcription 3, nuclear factor-κB and nuclear factor of activated T cells pathways. Br J Dermatol 2020; 182: 147–155. DOI: https://doi.org/10.1111/bjd.18098
Gallardo F, Pujol RM. Genetics abnormalities with clinical impact in primary cutaneous lymphomas. Cancers (Basel) 2022; 14: 4972. DOI: https://doi.org/10.3390/cancers14204972
Maurus K, Appenzeller S, Roth S, Brändlein S, Kneitz H, Goebeler M, et al. Recurrent oncogenic JAK and STAT alterations in cutaneous CD30-positive lymphoproliferative disorders. J Invest Dermatol 2020; 140: 2023–2031.e1. DOI: https://doi.org/10.1016/j.jid.2020.02.019
Mathew D, Marmarelis ME, Foley C, Bauml JM, Ye D, Ghinnagow R, et al. Combined JAK inhibition and PD-1 immunotherapy for non-small cell lung cancer patients. Science 2024; 384: eadf1329. DOI: https://doi.org/10.1126/science.adf1329
Zak J, Pratumchai I, Marro BS, Marquardt KL, Zavareh RB, Lairson LL, et al. JAK inhibition enhances checkpoint blockade immunotherapy in patients with Hodgkin lymphoma. Science 2024; 384: eade8520. DOI: https://doi.org/10.1126/science.ade8520
Lévy R, Fusaro M, Guerin F, Chetouani A, Moshous D, Fischer A, et al. Efficacy of ruxolitinib in subcutaneous panniculitis-like T-cell lymphoma and hemophagocytic lymphohistiocytosis. Blood Adv 2020; 4: 1383–1387. DOI: https://doi.org/10.1182/bloodadvances.2020001497
Zhang Q, Zhou C-J, Li D-H, Cui L, Li W-J, Ma H-H, et al. Efficacy of ruxolitinib for HAVCR2 mutation-associated hemophagocytic lymphohistiocytosis and panniculitis manifestations in children. Br J Haematol 2023; 202: 135–146. DOI: https://doi.org/10.1111/bjh.18817
Moskowitz AJ, Ghione P, Jacobsen E, Ruan J, Schatz JH, Noor S, et al. A phase 2 biomarker-driven study of ruxolitinib demonstrates effectiveness of JAK/STAT targeting in T-cell lymphomas. Blood 2021; 138: 2828–2837. DOI: https://doi.org/10.1182/blood.2021013379
Karagianni F, Piperi C, Casar B, de la Fuente-Vivas D, García-Gómez R, Lampadaki K, et al. Combination of resminostat with ruxolitinib exerts antitumor effects in the chick embryo chorioallantoic membrane model for cutaneous T cell lymphoma. Cancers (Basel) 2022; 14: 1070. DOI: https://doi.org/10.3390/cancers14041070
Knapp C, Steele E, Mengden-Koon S, Williams T, Fett N. A case of tofacitinib-induced lymphomatoid papulosis with ocular involvement. Am J Dermatopathol 2022; 44: 523–525. DOI: https://doi.org/10.1097/DAD.0000000000002219
Vadivel CK, Gluud M, Torres-Rusillo S, Boding L, Willerslev-Olsen A, Buus TB, et al. JAK3 is expressed in the nucleus of malignant T cells in cutaneous T cell lymphoma (CTCL). Cancers (Basel) 2021; 13: 280. DOI: https://doi.org/10.3390/cancers13020280
Kook H, Park SY, Hong N, Lee DH, Jung HJ, Park MY, et al. Severely pruritic mycosis fungoides successfully treated with upadacitinib. J Dtsch Dermatol Ges 2024; 22: 450–451. DOI: https://doi.org/10.1111/ddg.15325
Castillo DE, Romanelli P, Lev-Tov H, Kerdel F. A case of erythrodermic mycosis fungoides responding to upadacitinib. JAAD Case Rep 2022; 30: 91–93. DOI: https://doi.org/10.1016/j.jdcr.2022.10.010
Mo S, Friedmann D. Cutaneous T-cell lymphoma in a JAK inhibitor patient: a case report. SAGE Open Med Case Rep 2024; 12: 2050313X241231491. DOI: https://doi.org/10.1177/2050313X241231491
Hsieh C-Y, Tsai T-F. Rapid progression of cutaneous T-cell lymphoma in a patient with erythroderma during dupilumab treatment, following prior sequential azathioprine, baricitinib and cyclosporine treatments. Indian J Dermatol Venereol Leprol 2023; 1–3. DOI: https://doi.org/10.25259/IJDVL_1090_2022
Saito K, Shimauchi T, Kageyama R, Furukawa S, Suzuki N, Ginoza A, et al. A case of Sézary syndrome in a patient during treatment with baricitinib for seronegative rheumatoid arthritis. Clin Exp Dermatol 2023; 48: 391–393. DOI: https://doi.org/10.1093/ced/llac124
Kołkowski K, Trzeciak M, Sokołowska-Wojdyło M. Safety and danger considerations of novel treatments for atopic dermatitis in context of primary cutaneous lymphomas. Int J Mol Sci 2021; 22: 13388. DOI: https://doi.org/10.3390/ijms222413388
Tracey L, Villuendas R, Dotor AM, Spiteri I, Ortiz P, Garcia JF, et al. Mycosis fungoides shows concurrent deregulation of multiple genes involved in the TNF signaling pathway: an expression profile study. Blood 2003; 102: 1042–1050. DOI: https://doi.org/10.1182/blood-2002-11-3574
Vowels BR, Lessin SR, Cassin M, Jaworsky C, Benoit B, Wolfe JT, et al. Th2 cytokine mRNA expression in skin in cutaneous T-cell lymphoma. J Invest Dermatol 1994; 103: 669–673. DOI: https://doi.org/10.1111/1523-1747.ep12398454
Krejsgaard T, Lindahl LM, Mongan NP, Wasik MA, Litvinov IV, Iversen L, et al. Malignant inflammation in cutaneous T-cell lymphoma: a hostile takeover. Semin Immunopathol 2017; 39: 269–282. DOI: https://doi.org/10.1007/s00281-016-0594-9
Geskin LJ, Viragova S, Stolz DB, Fuschiotti P. Interleukin-13 is overexpressed in cutaneous T-cell lymphoma cells and regulates their proliferation. Blood 2015; 125: 2798–2805. DOI: https://doi.org/10.1182/blood-2014-07-590398
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