Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Treatment of refractory IgA vasculitis with dapsone: a systematic review

  • Received : 2019.05.15
  • Accepted : 2019.09.23
  • Published : 2020.05.15
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Abstract

IgA vasculitis, formerly known as Henoch-Schönlein purpura, is a systemic IgA-mediated vasculitis of the small vessels commonly seen in children. The natural history of IgA vasculitis is generally self-limiting; however, one-third of patients experience symptom recurrence and a refractory course. This systematic review examined the use of dapsone in refractory IgA vasculitis cases. A literature search of PubMed databases retrieved 13 articles published until June 14, 2018. The most common clinical feature was a palpable rash (100% of patients), followed by joint pain (69.2%). Treatment response within 1-2 days was observed in 6 of 26 patients (23.1%) versus within 3-7 days in 17 patients (65.4%). Relapse after treatment discontinuation was reported in 17 patients (65.4%) but not in 3 patients (11.5 %). Four of the 26 patients (15.4%) reported adverse effects of dapsone including arthralgia (7.7%), rash (7.7%), and dapsone hypersensitivity syndrome (3.8%). Our findings suggest that dapsone may affect refractory IgA vasculitis. Multicenter randomized placebo-controlled trials are necessary to determine the standard dosage of dapsone at initial or tapering of treatment in IgA vasculitis patients and evaluate whether dapsone has a significant benefit versus steroids or other medications.

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References

  1. Saulsbury FT. Henoch-Schonlein purpura. Curr Opin Rheumatol 2010;22:598-602. https://doi.org/10.1097/BOR.0b013e32833af608
  2. Tizard EJ, Hamilton-Ayres MJ. Henoch-Schonlein Purpura. Arch Dis Child Educ Pract Ed 2008;93:1-8. https://doi.org/10.1136/adc.2004.066035
  3. Shin JI, Park JM, Shin YH, Hwang DH, Kim JH, Lee JS. Predictive factors for nephritis, relapse, and significant proteinuria in childhood Henoch- Schonlein purpura. Scand J Rhematol 2006;35:56-60. https://doi.org/10.1080/03009740510026841
  4. Heineke MH, Ballering AV, Jamin, A, Ben Mkaddem S, Monteiro RC, Van Egmond M. New insights in the pathogenesis of immunoglobulin A vasculitis (Henoch-Schonlein purpura). Autoimmun Rev 2017;16:1246-53. https://doi.org/10.1016/j.autrev.2017.10.009
  5. Park SJ, Suh JS, Lee JH, Lee JW, Kim SH, Han KH, Shin JI. Advances in our understanding of the pathogenesis of Henoch-Schonlein purpura and the implications for improving its diagnosis. Expert Rev Clin Immunol 2013;9:1223-38. https://doi.org/10.1586/1744666X.2013.850028
  6. Shin JI. Henoch-Schonlein purpura nephritis. In: Geary DF, Schaefer F, editors. Pediatric kidney disease. New York: Springer, 2016;781-98.
  7. Papandreou T, Durken M, Goebeler M, Hoeger PH, Goerdt S, Peitsch WK. Chronic recalcitrant Henoch-Schonlein purpura: successful treatment with dapsone. Eur J Dermatol 2010;20:639-40.
  8. Fredenberg MF, Malkinson FD. Sulfone therapy in the treatment of leukocytoclastic vasculitis. J Am Acad Dermatol 1987;16:772-8. https://doi.org/10.1016/S0190-9622(87)70100-5
  9. Iqbal H, Evans A. Dapsone therapy for Henoch-Schonlein purpura: a case series. Arch Dis Child 2005;90:985. https://doi.org/10.1136/adc.2004.061598
  10. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264-9, W64. https://doi.org/10.7326/0003-4819-151-4-200908180-00135
  11. Ledermann JA, Hoffbrand BI. Dapsone in allergic vasculitis: its use in Henoch-Schonlein diseasefollowing vaccination. J R Soc Med 1983;76:613-4. https://doi.org/10.1177/014107688307600717
  12. Jayavardhana A, Vijayalakshmi AM. Dapsone hypersensitivity syndrome during Henoch-Schonlein purpura treatment. Indian Dermatol Online J 2014;5:93-4. https://doi.org/10.4103/2229-5178.126052
  13. Bech AP, Reichert LJ, Cohen Tervaert JW. Dapsone for the treatment of chronic HSP (Henoch-Schonlein). Neth J Med 2013;71:220-1.
  14. Shimomura N, Kawai K, Watanabe S, Katsuumi K, Ito M. Adult Henoch-Schonlein purpura with severe abdominal pain treated with dapsone and factor XIII concentrate. J Dermatol 2005; 32:124-7. https://doi.org/10.1111/j.1346-8138.2005.tb00729.x
  15. Ramelli GP, Bianchetti MG. Dapsone in cutaneous Henoch-Schonlein syndrome--worth a trial. Acta Paediatr 1997;86:337. https://doi.org/10.1111/j.1651-2227.1997.tb08907.x
  16. Sarma PSA. Dapsone in Henoch-Schonlein purpura. Postgrad. Med J 1994;70:464-5. https://doi.org/10.1136/pgmj.70.824.464
  17. Hoffbrand BI. Dapsone in Henoch-Schonlein purpura--worth a trial. Postgrad Med J 1991;67:961-2. https://doi.org/10.1136/pgmj.67.793.961
  18. Chen CB, Garlapati S, Lancaster JD, Zinn Z, Bacaj P, Patra, KP. Bullous Henoch-Schonlein purpura in children. Cutis 2015;96:248-52.
  19. Saulsbury FT. Henoch-Schonlein Purpura in children. Report of 100 patients and review of the literature. Medicine (Baltimore) 1999;78:395-409. https://doi.org/10.1097/00005792-199911000-00005
  20. Haroon M. Should children with Henoch-Schonlein purpura and abdominal pain be treated with steroids? Arch Dis Child 2005;90:1196-8. https://doi.org/10.1136/adc.2005.077743
  21. Ronkainen J, Koskimies O, Ala-Houhala M. Early prednisone therapy in Henoch-Schonlein Purpura: a randomized, double-blind, placebo-controlled trial. J Pediatr 2006;149:241-7. https://doi.org/10.1016/j.jpeds.2006.03.024
  22. Calvo-Rio V, Hernandez JL, Ortiz-Sanjuan F, Loricera J, Palmou-Fontana N, Gonzalez-Vela MC, et al. Relapses in patients with Henoch-Schonlein purpura: analysis of 417 patients from a single center. Medicine (Baltimore) 2016;95:e4217. https://doi.org/10.1097/md.0000000000004217
  23. Prais D, Amir J, Nussinovitch M. Recurrent Henoch-Schonlein purpura in children. J Clin Rheumatol 2007;13:25-8. https://doi.org/10.1097/01.rhu.0000255692.46165.19
  24. Fotis L, Tuttle PV 4th, Baszis KW, Pepmueller PH, Moore TL, White AJ. Azathioprine therapy for steroid-resistant Henoch-Schonlein purpura: a report of 6 cases. Pediatr Rheumatol Online J 2016;14:37. https://doi.org/10.1186/s12969-016-0100-x
  25. Shin JI, Lee JS. Severe gastrointestinal vasculitis in Henoch-Schoenlein purpura: pathophysiologic mechanisms, the diagnostic value of factor XIII, and therapeutic options. Eur J Pediatr 2007;166:1199-200. https://doi.org/10.1007/s00431-007-0415-1
  26. Lamireau T, Rebouissoux L, Hehunstre JP. Intravenous immunoglobulin therapy for severe digestive manifestations of Henoch-Schonlein purpura. Acta Paediatr 2001;90:1081-2.
  27. Kawakami T, Shirai S, Kimura K, Soma Y. Successful use of mizoribine to treat recurrent corticosteroid-resistant palpable purpura in a patient with henoch-schonlein purpura nephritis. Arch Dermatol 2010;146:212-3. https://doi.org/10.1001/archdermatol.2009.371
  28. Shin JI, Park JM, Shin YH, Kim JH, Kim PK, Lee JS, et al. Cyclosporin A therapy for severe Henoch-Schonlein nephritis with nephrotic syndrome. Pediatr Nephrol 2005;20:1093-7. https://doi.org/10.1007/s00467-005-1864-2
  29. Lee KH, Park JH, Kim DH, Hwang J, Lee G, Hyun JS, et al. Dapsone as a potential treatment option for Henoch-Schonlein Purpura (HSP). Med Hypotheses 2017;108:42-5. https://doi.org/10.1016/j.mehy.2017.07.018
  30. WHO Study Group on Chemotherapy of Leprosy for Control Programmes & World Health Organization. Chemotherapy of leprosy for control programmes: report of a WHO study group [meeting held in Geneva from 12 to 16 October 1981]. Geneva (Switzerland): World Health Organization, 1982.
  31. Pieters FA, Zuidema, J. The pharmacokinetics of dapsone after oral administration to healthy volunteers. Br J Clin Pharmacol 1986;22:491-4. https://doi.org/10.1111/j.1365-2125.1986.tb02924.x
  32. Venkatesan K. Clinical pharmacokinetic considerations in the treatment of patients with leprosy. Clin Pharmacokinet 1989;16:365-86. https://doi.org/10.2165/00003088-198916060-00003
  33. Zuidema J, Hilbers-Modderman ES, Merkus FW. Clinical pharmacokinetics of dapsone. Clin Pharmacokinet 1986;11:299-315. https://doi.org/10.2165/00003088-198611040-00003
  34. Coleman MD. Dapsone: modes of action, toxicity and possible strategies for increasing patient tolerance. Br J Dermatol 1993;129:507-13. https://doi.org/10.1111/j.1365-2133.1993.tb00476.x
  35. Byrd SR, Gelber RH. Effect of dapsone on haemoglobin concentration in patients with leprosy. Lepr Rev 1991;62:171-8.
  36. Balakrishnan S, Karthikeyan S, Ramu G. Investigations into the haemolytic effects of dapsone therapy in leprosy patients. Indian J Lepr 1989;61:10-6.
  37. Coleman MD. Dapsone toxicity: some current perspectives. Gen Pharmacol 1995;26:1461-7. https://doi.org/10.1016/0306-3623(95)00029-1
  38. Kumar RH, Kumar MV, Thappa DM. Dapsone syndrome--a five year retrospective analysis. Indian J Lepr 1998;70:271-6.
  39. Prussick R, Shear NH. Dapsone hypersensitivity syndrome. J Am Acad Dermatol 1996;35:346-9. https://doi.org/10.1016/S0190-9622(96)90667-2
  40. Koller WC, Gehlmann LK, Malkinson FD, Davis FA. Dapsone-induced peripheral neuropathy. Arch Neurol 1977;34:644-6. https://doi.org/10.1001/archneur.1977.00500220078017
  41. Sirsat AM, Lalitha VS, Pandya SS. Dapsone neuropathy--report of three cases and pathologic features of a motor nerve. Int J Lepr Other Mycobact Dis 1987;55:23-9.
  42. Fine JD, Katz SI, Donahue MJ, Hendricks AA. Psychiatric reaction to dapsone and sulfapyridine. J Am Acad Dermatol 1983;9:274-5. https://doi.org/10.1016/S0190-9622(83)80147-9
  43. Gawkrodger D. Manic depression induced by dapsone in patient with dermatitis herpetiformis. BMJ 1989;299:860. https://doi.org/10.1136/bmj.299.6703.860-c

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