IgA vasculitis in patients with inflammatory bowel disease: new insights into the role of TNF-α blockers. (24th August 2021)

• Record Type: Journal Article
• Authors: Rasmussen, Camille; Abitbol, Vered; El Karoui, Khalil; Bourrier, Anne; Paule, Romain; Vuitton, Lucine; Maurier, François; Laharie, David; Fuméry, Mathurin; Agard, Christian; Collins, Michael; Nancey, Stephane; Rafat, Cédric; Kervegant, Anne-Gaëlle; Queyrel-Moranne, Viviane; Moulis, Guillaume; Pigneur, Bénédicte; Régent, Alexis; Gay, Claire; Morbieu, Caroline; Durel, Cécile Audrey; Ducloux, Didier; Aubin, François; Voicu, Mickaela; Joher, Nizar; Szwebel, Tali; Martinez-Vinson, Christine; Koch, Stéphane; Guillevin, Loïc; Peyrin-Biroulet, Laurent; Terrier, Benjamin;
• Is Part Of: Rheumatology. Volume 61:Number 5(2022)
• Page Start: 1957
• Page End: 1965
• Publication Date: 2021-08-24
• Subjects: IgA vasculitis -- inflammatory bowel disease -- Crohn's disease -- ulcerative colitis -- anti-TNF therapy; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keab662
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objective: The association of IgA vasculitis (IgAV) and IBD is rarely described, mainly during anti-TNF-α therapy. We aimed to describe the association of IgAV and IBD. Methods: We retrospectively analysed the association of IgAV and IBD through the implication of the GETAID and FVSG networks. Characteristics of IBD and IgAV were collected using a standardized case report form. Results: Forty-three cases were included. IBD [mainly Crohn's disease (CD) in 58%] preceded IgAV in 38 (88%), with median interval of 9.2 (IQR 5.4–15.4) years. In these 38 patients, at IgAV diagnosis, five (13%) had active IBD and 28 (74%) were treated with anti-TNF-α for a median duration of 31.5 (IQR 19–56) months. Main IgAV manifestations were purpura all patients (100%), joints in 20/35 (57%), renal in 15/35 (43%) and gastrointestinal in 11/35 (31%) involvement. IgAV was treated with glucocorticoids in 25 (66%), colchicine in six (16%), CYC in six (16%) and anti-TNF-α were discontinued in 15/28 (54%). No IgAV relapse occurred when TNF-α blockers were stopped, vs 23% in patients pursuing it. Conversely, five (33%) had IBD flare or complication after anti-TNF-α cessation vs one (8%) in those continuing biologics. Anti-TNF-α were resumed in six (40%), with subsequent IgAV relapse in four (67%). Conclusions: This large cohort suggests that TNF-α blockers may promote the onset of IgAV in IBD. Discontinuation of anti-TNF-α was associated with vasculitis remission but increased risk of IBD relapses, whereas continuation of anti-TNF-α was associated with IBD remission but vasculitis relapse.