Characteristics and Management of IgA Vasculitis (Henoch-Schonlein) in Adults Data From 260 Patients Included in a French Multicenter Retrospective Survey

Alexandra Audemard-Verger 1 Benjamin Terrier 2 Agnès Dechartres 3 Johan Chanal 4 Zahir Amoura 5 Noémie Le Gouellec 6 Patrice Cacoub 7 Noemie Jourde‑chiche 8, 9 Geoffrey Urbanski 10 François Augusto 10 Guillaume Moulis 11 Loïc Raffray 12 Alban Deroux 13 Aurélie Hummel 14 Bertrand Lioger 15 Melanie Catroux 16 Stanislas Faguer 17 Julie Goutte 18 Nihal Martis 19 François Maurier 20 Etienne Rivière 21 Sébastien Sanges 22 Aurélie Baldolli 23 Nathalie Costedoat-Chalumeau 2 Mélanie Roriz 24 Xavier Puéchal 4 Marc André 25 Christian Lavigne 10 Boris Bienvenu 26 Arsene Mekinian 27 Elie Zagdoun Charlotte Girard 28 Alice Bérezné 1 Loïc Guillevin 29 Eric Thervet 30 Evangeline Pillebout 31
Abstract : Methods: Data on clinical characteristics, histologic features, and treatment response from 260 patients with IgAV included in a French multicenter retrospective survey were analyzed. Efficacy data were compared using different statistical models. Results: The mean ± SD age of the patients with IgAV at diagnosis was 50.1 ± 18 years, and 63% of patients were male. Baseline manifestations included purpura (100%), arthralgias/arthritis/myalgia (61%), glomerulonephritis (70%), and/or gastrointestinal involvement (53%). Thirty percent of patients showed renal failure at baseline. In univariate analysis, the response to therapy was 80% (64 of 80) in patients treated with corticosteroids (CS) alone, compared to 77% (23 of 30) in patients treated with CS plus cyclophosphamide (CYC) and 59% (10 of 17) in patients treated with colchicine (P = 0.17). Multivariable analysis showed that treatment with CS or CS plus CYC was more effective than colchicine in achieving a response. Efficacy differences were demonstrated using different statistical models: in the multivariable logistic regression model, odds ratio (OR) 3.68, 95% confidence interval (95% CI) 1.10–12.33 (P = 0.03); in the inverse probability weighting on propensity score model, OR 3.75, 95% CI 1.28–10.99 (P = 0.02). The efficacy of CS plus CYC as compared to CS alone was discordant according to the analytic method used. Analysis with the multivariable logistic regression model did not demonstrate a difference between CS plus CYC and CS alone (OR 0.88, 95% CI 0.29–2.67; P = 0.82). In contrast, inverse probability weighting on propensity score showed that CS plus CYC was more effective than CS alone (OR 1.79, 95% CI 1.00–3.20; P = 0.049). Conclusion: This series constitutes the largest series of adults with IgAV reported in the literature so far. It provides data on clinical and histologic presentation and therapeutic efficacy, suggesting that CS alone appears to be a reasonable first‐line therapy in patients with IgAV, while the benefit of adding CYC to CS remains uncertain.
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Arthritis & rheumatology, Wiley, 2017, 69 (9), pp.1862-1870. 〈10.1002/art.40178〉
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Alexandra Audemard-Verger, Benjamin Terrier, Agnès Dechartres, Johan Chanal, Zahir Amoura, et al.. Characteristics and Management of IgA Vasculitis (Henoch-Schonlein) in Adults Data From 260 Patients Included in a French Multicenter Retrospective Survey. Arthritis & rheumatology, Wiley, 2017, 69 (9), pp.1862-1870. 〈10.1002/art.40178〉. 〈hal-01787239〉

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