Clinical and Experimental Pediatrics (May 2020)

Treatment of refractory IgA vasculitis with dapsone: a systematic review

  • Keum Hwa Lee,
  • Sung Hwi Hong,
  • Jinhae Jun,
  • Youngheun Jo,
  • Woogyeong Jo,
  • Dayeon Choi,
  • Jeongho Joo,
  • Guhyun Jung,
  • Sunghee Ahn,
  • Andreas Kronbichler,
  • Michael Eisenhut,
  • Jae Il Shin

DOI
https://doi.org/10.3345/kjp.2019.00514
Journal volume & issue
Vol. 63, no. 5
pp. 158 – 163

Abstract

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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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