Biologics for immunoglobulin A vasculitis: targeting vasculitis or comorbid disease?
Anti-TNF agents
Biologics
Henoch–Schönlein purpura
IgA vasculitis
Rituximab
bDMARDs
Journal
Internal and emergency medicine
ISSN: 1970-9366
Titre abrégé: Intern Emerg Med
Pays: Italy
ID NLM: 101263418
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
received:
30
08
2021
accepted:
01
03
2022
pubmed:
30
3
2022
medline:
14
9
2022
entrez:
29
3
2022
Statut:
ppublish
Résumé
In this study, we aimed to evaluate the clinical features and treatments, including the use of biological disease-modifying anti-rheumatic drugs (bDMARDs) in a large cohort of pediatric and adult immunoglobulin A vasculitis (IgAV). Since data on the use of bDMARDs in IgAV are very limited, we collated the reasons for use of bDMARDs during the disease course. Patients who were enrolled in the Hacettepe University Vasculitis Research Centre (HUVAC) registry were included. In this prospective database dating from 2014, there were 436 IgAV patients classified as IgAV according to Ankara 2008 and/or American College of Rheumatology 1990 criteria. 88 adults and 330 pediatric IgAV patients were included as the main study group. Concomitant spondyloarthritis (SpA) was observed only in adult patients (10% vs 0% in children, p < 0.001). IgAV relapse was more common in adults than in children (p: 0.017). Adult patients were mostly treated with corticosteroid (p < 0.001) and conventional synthetic disease-modifying anti-rheumatic drug treatment (< 0.001), while more than half of the pediatric patients were followed up without immunosuppressive treatment. Ten (11%) adult patients used biologics. Among them, two patients used rituximab due to IgAV disease activity, three used infliximab due to SpA, three used etanercept due to SpA (one patient had a pediatric onset enthesitis-related arthritis), and two used anakinra due to recurrent familial Mediterranean fever attacks. This is the first study evaluating the use of all bDMARDs for any reason in the IgAV cohorts in the literature. None of the pediatric patients used biologics. Our data suggest biologics are mainly used for comorbid inflammatory diseases over refractory vasculitis in adult IgAV.
Identifiants
pubmed: 35347546
doi: 10.1007/s11739-022-02968-0
pii: 10.1007/s11739-022-02968-0
doi:
Substances chimiques
Biological Products
0
Immunoglobulin A
0
Rituximab
4F4X42SYQ6
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1599-1608Informations de copyright
© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).
Références
Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F et al (2013) 2012 revised international Chapel Hill consensus conference nomenclature of vasculitides. Arthritis Rheum 65(1):1–11
pubmed: 23045170
Brogan P, Eleftheriou D, Dillon M (2010) Small vessel vasculitis. Pediatr Nephrol 25(6):1025–1035
pubmed: 19885685
Pillebout E, Thervet E, Hill G, Alberti C, Vanhille P, Nochy D (2002) Henoch-Schonlein purpura in adults: outcome and prognostic factors. J Am Soc Nephrol 13(5):1271–1278
pubmed: 11961015
Batu ED, Sari A, Erden A, Sonmez HE, Armagan B, Kalyoncu U et al (2018) Comparing immunoglobulin A vasculitis (Henoch-Schonlein purpura) in children and adults: a single-centre study from Turkey. Scand J Rheumatol 47(6):481–486
pubmed: 29912602
Audemard-Verger A, Terrier B, Dechartres A, Chanal J, Amoura Z, Le Gouellec N et al (2017) Characteristics and management of IgA vasculitis (Henoch-Schonlein) in adults: data from 260 patients included in a French Multicenter Retrospective Survey. Arthritis Rheumatol 69(9):1862–1870
pubmed: 28605168
Maritati F, Canzian A, Fenaroli P, Vaglio A (2020) Adult-onset IgA vasculitis (Henoch-Schonlein): update on therapy. Presse Med. 49(3):104035
pubmed: 32645417
Hernandez-Rodriguez J, Carbonell C, Miron-Canelo JA, Diez-Ruiz S, Marcos M, Chamorro AJ (2020) Rituximab treatment for IgA vasculitis: a systematic review. Autoimmun Rev. 19(4):102490
pubmed: 32062030
Fenoglio R, Sciascia S, Naretto C, De Simone E, Del Vecchio G, Ferro M et al (2020) Rituximab in severe immunoglobulin-A vasculitis (Henoch-Schonlein) with aggressive nephritis. Clin Exp Rheumatol. 124(2):195–200
Maritati F, Fenoglio R, Pillebout E, Emmi G, Urban ML, Rocco R et al (2018) Brief report: rituximab for the treatment of adult-onset IgA vasculitis (Henoch-Schonlein). Arthritis Rheumatol 70(1):109–114
pubmed: 28973844
Paroli M (2012) Clinical use of biologics in vasculitis syndromes. Biologics 6:371–378
pubmed: 23118526
pmcid: 3484501
Stone JH, Merkel PA, Spiera R, Seo P, Langford CA, Hoffman GS et al (2010) Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med 363(3):221–232
pubmed: 20647199
pmcid: 3137658
Yates M, Watts RA, Bajema IM, Cid MC, Crestani B, Hauser T et al (2016) EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis. Ann Rheum Dis 75(9):1583–1594
pubmed: 27338776
Hellmich B, Agueda A, Monti S, Buttgereit F, de Boysson H, Brouwer E et al (2020) 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 79(1):19–30
pubmed: 31270110
Ombrello AK, Qin J, Hoffmann PM, Kumar P, Stone D, Jones A et al (2019) Treatment strategies for deficiency of adenosine deaminase 2. N Engl J Med 380(16):1582–1584
pubmed: 30995379
pmcid: 7372950
Rolle AS, Zimmermann B, Poon SH (2013) Etanercept-induced Henoch-Schonlein purpura in a patient with ankylosing spondylitis. J Clin Rheumatol 19(2):90–93
pubmed: 23364662
Pindi Sala T, Michot JM, Snanoudj R, Dollat M, Esteve E, Marie B et al (2014) Successful outcome of a corticodependent henoch-schonlein purpura adult with rituximab. Case Rep Med. 2014:619218
pubmed: 24799911
pmcid: 3988713
Song Y, Shi YH, He C, Liu CQ, Wang JS, Zhao YJ et al (2015) Severe Henoch-Schonlein purpura with infliximab for ulcerative colitis. World J Gastroenterol 21(19):6082–6087
pubmed: 26019477
pmcid: 4438047
LaConti JJ, Donet JA, Cho-Vega JH, Sussman DA, Ascherman D, Deshpande AR (2016) Henoch-Schonlein purpura with adalimumab therapy for ulcerative colitis: a case report and review of the literature. Case Rep Rheumatol 2016:2812980
pubmed: 27529048
pmcid: 4978839
Fenoglio R, Naretto C, Basolo B, Quattrocchio G, Ferro M, Mesiano P et al (2017) Rituximab therapy for IgA-vasculitis with nephritis: a case series and review of the literature. Immunol Res 65(1):186–192
pubmed: 27449502
Atas N, Armagan B, Bodakci E, Satis H, Sari A, Bilge NSY et al (2020) Familial Mediterranean fever is associated with a wide spectrum of inflammatory disorders: results from a large cohort study. Rheumatol Int 40(1):41–48
pubmed: 31392498
John KJ, Sadiq M, Thomas M, Turaka VP (2019) Henoch-Schonlein purpura associated with HLA-B27 positive axial spondyloarthritis in a young man. BMJ Case Rep. 12(5):e228881
pubmed: 31129640
pmcid: 6536201
Beauvais C, Kaplan G, Mougenot B, Michel C, Marinho E (1993) Cutaneous vasculitis and IgA glomerulonephritis in ankylosing spondylitis. Ann Rheum Dis 52(1):61–62
pubmed: 8427517
pmcid: 1004958
Karadag OBS, Armagan B, Sari A, Erden A, Batu ED, Arici S, Sonmez HE, Kiraz S, Ozen S (2017) Two-year results of a prospective vasculitis cohort from eastern mediterranean: demographic characteristics and distribution of the vasculitides frequencies. Rheumatology. 56:iii88–iii95
Ozen S, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R et al (2010) EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: final classification criteria. Ann Rheum Dis 69(5):798–806
pubmed: 20413568
Mills JA, Michel BA, Bloch DA, Calabrese LH, Hunder GG, Arend WP et al (1990) The American College of Rheumatology 1990 criteria for the classification of Henoch-Schonlein purpura. Arthritis Rheum 33(8):1114–1121
pubmed: 2202310
Kang Y, Park JS, Ha YJ, Kang MI, Park HJ, Lee SW et al (2014) Differences in clinical manifestations and outcomes between adult and child patients with Henoch-Schonlein purpura. J Korean Med Sci 29(2):198–203
pubmed: 24550645
pmcid: 3923997
Garcia-Porrua C, Calvino MC, Llorca J, Couselo JM, Gonzalez-Gay MA (2002) Henoch-Schonlein purpura in children and adults: clinical differences in a defined population. Semin Arthritis Rheum 32(3):149–156
pubmed: 12528079
Blanco R, Martinez-Taboada VM, Rodriguez-Valverde V, Garcia-Fuentes M, Gonzalez-Gay MA (1997) Henoch-Schonlein purpura in adulthood and childhood: two different expressions of the same syndrome. Arthritis Rheum 40(5):859–864
pubmed: 9153547
Hung SP, Yang YH, Lin YT, Wang LC, Lee JH, Chiang BL (2009) Clinical manifestations and outcomes of Henoch-Schonlein purpura: comparison between adults and children. Pediatr Neonatol 50(4):162–168
pubmed: 19750891
Uppal SS, Hussain MA, Al-Raqum HA, Nampoory MR, Al-Saeid K, Al-Assousi A et al (2006) Henoch-Schonlein’s purpura in adults versus children/adolescents: a comparative study. Clin Exp Rheumatol 24(2 Suppl 41):S26-30
pubmed: 16859592
Nossent J, Raymond W, Keen H, Inderjeeth C, Preen DB (2019) Hospitalisation rates and characteristics for adult and childhood immunoglobulin A vasculitis in Western Australia. Intern Med J 49(4):475–481
pubmed: 30091295
Villatoro-Villar M, Crowson CS, Warrington KJ, Makol A, Ytterberg SR, Koster MJ (2019) Clinical characteristics of biopsy-proven IgA vasculitis in children and adults: a retrospective cohort study. Mayo Clin Proc 94(9):1769–1780
pubmed: 31486380
Calvo-Rio V, Loricera J, Mata C, Martin L, Ortiz-Sanjuan F, Alvarez L et al (2014) Henoch-Schonlein purpura in northern Spain: clinical spectrum of the disease in 417 patients from a single center. Medicine (Baltimore) 93(2):106–113
Aalberse J, Dolman K, Ramnath G, Pereira RR, Davin JC (2007) Henoch Schonlein purpura in children: an epidemiological study among Dutch paediatricians on incidence and diagnostic criteria. Ann Rheum Dis 66(12):1648–1650
pubmed: 17472987
pmcid: 2095299
Gazel U, Colak S, Sari A, Cansu DU, Yazici A, Cefle A et al (2020) Damage assessment in adult IgA vasculitis. Cross-sectional results of a multicentre cohort. Clin Exp Rheumatol. 124(2):155–160
Audemard-Verger A, Pillebout E, Guillevin L, Thervet E, Terrier B (2015) IgA vasculitis (Henoch-Shonlein purpura) in adults: diagnostic and therapeutic aspects. Autoimmun Rev 14(7):579–585
pubmed: 25688001
Oni L, Sampath S (2019) Childhood IgA vasculitis (Henoch Schonlein Purpura)-advances and knowledge gaps. Front Pediatr 7:257
pubmed: 31316952
pmcid: 6610473
Ozen S, Marks SD, Brogan P, Groot N, de Graeff N, Avcin T et al (2019) European consensus-based recommendations for diagnosis and treatment of immunoglobulin A vasculitis-the SHARE initiative. Rheumatology (Oxford) 58(9):1607–1616
Boyer EM, Turman M, O’Neil KM (2011) Partial response to anakinra in life-threatening Henoch-Schonlein purpura: case report. Pediatr Rheumatol Online J 9(1):21
pubmed: 21834965
pmcid: 3169465
Besbas N, Saatci U, Ruacan S, Ozen S, Sungur A, Bakkaloglu A et al (1997) The role of cytokines in Henoch Schonlein purpura. Scand J Rheumatol 26(6):456–460
pubmed: 9433407
Balci-Peynircioglu B, Kaya-Akca U, Arici ZS, Avci E, Akkaya-Ulum ZY, Karadag O et al (2020) Comorbidities in familial Mediterranean fever: analysis of 2000 genetically confirmed patients. Rheumatology (Oxford) 59(6):1372–1380
Poddubnyy D, Sieper J (2018) What is the best treatment target in axial spondyloarthritis: tumour necrosis factor alpha, interleukin 17, or both? Rheumatology (Oxford) 57(7):1145–1150
Gulhan B, Orhan D, Kale G, Besbas N, Ozen S (2015) Studying cytokines of T helper cells in the kidney disease of IgA vasculitis (Henoch-Schonlein purpura). Pediatr Nephrol 30(8):1269–1277
pubmed: 25648880
Jaszczura M, Mizgala-Izworska E, Swietochowska E, Machura E (2019) Serum levels of selected cytokines [interleukin (IL)-17A, IL-18, IL-23] and chemokines (RANTES, IP10) in the acute phase of immunoglobulin A vasculitis in children. Rheumatol Int 39(11):1945–1953
pubmed: 31468124
pmcid: 7575498
Lopez-Mejias R, Genre F, Remuzgo-Martinez S, Pulito-Cueto V, Sevilla-Perez B, Llorca J et al (2020) Influence of IL17A gene on the pathogenesis of immunoglobulin-A vasculitis. Clin Exp Rheumatol. 124(2):166–170
Montenegro V, Monteiro RC (1999) Elevation of serum IgA in spondyloarthropathies and IgA nephropathy and its pathogenic role. Curr Opin Rheumatol 11(4):265–272
pubmed: 10411380
Peeters AJ, van den Wall Bake AW, van Dalsen AD, Westedt ML (1988) Relation of microscopic haematuria in ankylosing spondylitis to circulating IgA containing immune complexes. Ann Rheum Dis 47(8):645–647
pubmed: 3415363
pmcid: 1006715
Canetta P (2020) Toward a clearer picture of IgA nephropathy in spondyloarthritis. Kidney Int Rep 5(6):766–768
pubmed: 32519999
pmcid: 7271943
Davin JC, Ten Berge IJ, Weening JJ (2001) What is the difference between IgA nephropathy and Henoch-Schonlein purpura nephritis? Kidney Int 59(3):823–834
pubmed: 11231337
Heineke MH, Ballering AV, Jamin A, Ben Mkaddem S, Monteiro RC, Van Egmond M (2017) New insights in the pathogenesis of immunoglobulin A vasculitis (Henoch-Schonlein purpura). Autoimmun Rev 16(12):1246–1253
pubmed: 29037908
Cowling P, Ebringer R, Ebringer A (1980) Association of inflammation with raised serum IgA in ankylosing spondylitis. Ann Rheum Dis 39(6):545–549
pubmed: 7458430
pmcid: 1000617
Collado A, Sanmarti R, Bielsa I, Castel T, Kanterewicz E, Canete JD et al (1988) Immunoglobulin A in the skin of patients with ankylosing spondylitis. Ann Rheum Dis 47(12):1004–1007
pubmed: 3061367
pmcid: 1003655