IgA vasculitis induced by tumor necrosis factor-α antagonists: clinical features, diagnosis and management

被引:0
作者
Yan, Lu [1 ,2 ]
Shen, Jie [1 ,2 ]
Liu, Lin [1 ,2 ]
Yang, Minghua [1 ,2 ]
Wang, Shengfeng [1 ,3 ]
机构
[1] Cent South Univ, Xiangya Hosp 3, Dept Pediat, Changsha 410013, Hunan, Peoples R China
[2] Cent South Univ, Xiangya Hosp 3, Hunan Clin Res Ctr Pediat Canc, Changsha 410013, Hunan, Peoples R China
[3] Cent South Univ, Xiangya Hosp 3, Dept Pharm, Changsha 410013, Hunan, Peoples R China
基金
中国国家自然科学基金;
关键词
TNF-alpha antagonist; Autoimmune diseases; Adverse events; IgA vasculitis; IgA with nephropathy; HENOCH-SCHONLEIN PURPURA; INFLIXIMAB THERAPY; CROHNS-DISEASE; CHILDHOOD; ARTHRITIS; SECONDARY; PATIENT; ADULTS;
D O I
10.1007/s00403-025-03965-x
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
IntroductionAnti-TNF therapies are commonly employed in the treatment of autoimmune disorders, yet they are associated with a rare side effect known as IgA vasculitis (IgAV), whose clinical presentation remains poorly understood. This study aims to clarify the features of IgAV linked to anti-TNF treatments to aid in prompt recognition and management.MethodsCase reports on TNF-alpha-antagonist-associated IgAV dated up to February 29, 2024, were retrieved for retrospective analysis.ResultsA total of 35 cases from 30 publications were identified. The average age of patients was 36 years (range 11 to 69), with 31.4% being pediatric cases. The primary conditions treated were Crohn's disease (45.7%) and ulcerative colitis (22.9%). Infliximab (42.9%) and adalimumab (37.1%) were the most frequently used agents. The onset of IgAV after initiating anti-TNF therapy occurred at a median of 10 months (range 1 day to 11 years). Clinical symptoms predominantly involved the skin (97.1%), kidneys (68.6%), joints (57.1%), and gastrointestinal tract (40.0%). Renal failure developed in 11.4% of patients. Histopathology revealed leukocytoclastic vasculitis in the skin and mainly proliferative nephritis in renal biopsies, with significant IgA deposition observed. Most patients (80.0%) ceased anti-TNF treatment, and the majority received corticosteroids (96.2%) and dapsone (15.4%) as part of their treatment. Remission was achieved in 34 patients, while one patient worsened. Among the 14 patients who restarted anti-TNF therapy, 9 experienced a recurrence of IgAV.ConclusionIgAV associated with anti-TNF therapy may emerge months into treatment and can lead to severe renal complications necessitating ongoing surveillance. Halting anti-TNF therapy is imperative, but the decision to resume treatment must be weighed carefully against the risk of primary disease exacerbation and IgAV recurrence.
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页数:10
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