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

      Background

      Cutaneous polyarteritis nodosa 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 cutaneous polyarteritis nodosa.

      Methods

      This multicenter retrospective, observational study, recorded clinical and biologic data together with treatments received. The primary outcome was the rate of complete response at month 3. Secondary outcomes assessed drug survival and safety.

      Results

      We included 68 patients who received a median of 2 therapeutic lines (interquartile range, 1-3). Overall, complete response was achieved in 13 of 42 (31%) patients with colchicine, 4 of 17 (23%) with dapsone, 11 of 25 (44%) with glucocorticoids (GCs) alone, 1 of 9 (11%) with nonsteroidal anti-inflammatory drugs, 11 of 13 (84%) with GCs+azathioprine, and 7 of 15 (47%) with GCs+methotrexate. GCs+azathioprine had the best drug survival (median duration, 29.5 months; interquartile range, 19.5-36.0). Response at month 3 was decreased with peripheral neurologic involvement (odds ratio, 0.19; 95% confidence interval, 0.03-0.81; P = .04). Overall, the rate of treatment-related adverse events was 18%, which led to the discontinuation of treatment in 7% of patients.

      Limitation

      Retrospective study.

      Conclusion

      Colchicine seems to confer good benefit-risk balance in cutaneous polyarteritis nodosa without peripheral sensory neuropathy. GCs+azathioprine seem the best treatment in the event of relapse.

      Key words

      Abbreviations used:

      AZA (azathioprine), CR (complete response), cPAN (cutaneous polyarteritis nodosa), CYC (cyclophosphamide), GCs (glucocorticoids), ISs (immunosuppressants), IQR (interquartile range), IVIgs (intravenous immunoglobulins), MTX (methotrexate), NSAIDs (nonsteroidal anti-inflammatory drugs), sPAN (systemic polyarteritis nodosa)
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