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

Abstract

Introduction

Anti-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.

Methods

Case reports on TNF-α-antagonist-associated IgAV dated up to February 29, 2024, were retrieved for retrospective analysis.

Results

A 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.

Conclusion

IgAV 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.