Efficacy and safety of treatments in cutaneous polyarteritis nodosa: a French observational retrospective study

Background

Cutaneous polyarteritis nodosa (cPAN) is a form of medium-sized vessel vasculitis. Despite a disabling and prolonged course, data on treatment efficacy and safety remain scarce.

Objectives

We aimed to describe treatment efficacy and safety in patients with cPAN.

Methods

This was a multicentre retrospective observational study, recording clinical and biological data together with treatments received. The primary outcome was the rate of complete response (CR) at month 3. Secondary outcomes included drug survival, and safety was assessed.

Results

We included 68 patients who received a median of 2 therapeutic lines (interquartile range 1-3). Overall, 13/42 (31%) patients achieved CR with colchicine, 4/17 (23%) with dapsone, 11/25 (44%) with glucocorticoids (GCs) alone, 1/9 (11%) with NSAIDs, 11/13 (84%) with GCs+azathioprine (AZA) and 7/15 (47%) with GCs+methotrexate. GCs+AZA had the best drug survival (median duration 29.5 months [IQR 19.5-36.0]). Response at month 3 was decreased with peripheral neurological involvement (odds ratio 0.19 [95% confidence interval 0.03-0.81], p=0.04). Overall, the rate of treatment-related adverse events was 18%, which led to treatment discontinuation in 7% of patients.

Limitation

Retrospective study

Conclusion

Colchicine seems to confer good benefit–risk balance in cPAN without peripheral sensory neuropathy. GCs+AZA seems the best treatment for disease relapse.

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