Rituximab as possible therapy in TNF inhibitor-induced IgA vasculitis with severe renal involvement

Background We observe the increasing use of tumor necrosis factor (TNF) inhibitors in patients affected by chronic inflammatory diseases. These drugs provide good control of symptoms, contributing to significant improvement in the quality of life in individuals with high disease burden. On the other hand, along with their wider use and longer follow-up periods the number of reports regarding their adverse effects is also increasing. The reported complications include drug-induced vasculitis with possible kidney involvement. In the literature we can distinguish more frequently described ANCA-associated vasculitis and more rarely occurring immunoglobulin A vasculitis. Although uncommon, such complications may present with potentially life-threatening vital organ dysfunction; therefore, adequate monitoring and effective therapy are necessary. Case presentation We report two cases of TNF inhibitor-induced vasculitis with severe acute worsening of renal function and significant proteinuria. The first patient was receiving golimumab therapy for ankylosing spondylitis and the second patient was treated with adalimumab for psoriasis and psoriatic arthritis. In the second case dialysis treatment was necessary and the patient presented recurrence of vasculitis after rechallenge with adalimumab. Both patients underwent renal biopsy which showed findings compatible with drug-induced IgA vasculitis and both were treated successfully with corticosteroids and rituximab. Conclusions To the best of our knowledge this is the first report of rituximab use in drug-induced IgA vasculitis with renal involvement. Combination of corticosteroids and rituximab can be an effective therapy in case of vasculitis with kidney failure and a preferable option for selected patients with drug-induced IgA vasculitis compared to cyclophosphamide. More studies are necessary to establish suitable short- and long-term treatment. Given the rarity of this disorder, case reports and case series can provide practical guidance until additional studies become available..

Key points Drug-induced vasculitis is a rare complication of anti-TNF therapy and can present with systemic (including renal) involvement. Careful monitoring during anti-TNF therapy, including serum creatinine and proteinuria (baseline and periodic follow-up exams), is essential to allow prompt diagnosis and treatment. TNF inhibitors can cause AAV and IgAV; kidney biopsy is a useful tool for confirming the diagnosis and introducing appropriate treatment. No guidelines regarding treatment are currently available. In the case of systemic involvement corticosteroid therapy and a second immunosuppressive agent (cyclophosphamide, rituximab) can be considered; in the case of IgAV rituximab may be preferable in selected patients. Maintenance therapy might not be necessary provided that the offending agent is withdrawn..

Medienart:	E-Artikel

Erscheinungsjahr:	2023
Erschienen:	2023

Enthalten in:	Zur Gesamtaufnahme - volume:24
Enthalten in:	BMC nephrology - 24(2023), 1 vom: 20. Dez.

Sprache:	Englisch

Beteiligte Personen:	Przygocka, Agnieszka [VerfasserIn] Berti, Gian Marco [VerfasserIn] Campus, Anita [VerfasserIn] Tondolo, Francesco [VerfasserIn] Vischini, Gisella [VerfasserIn] Fabbrizio, Benedetta [VerfasserIn] La Manna, Gaetano [VerfasserIn] Baraldi, Olga [VerfasserIn]

Links:	Volltext [kostenfrei]

Themen:	Acute kidney injury Adalimumab Drug-induced vasculitis Golimumab IgA vasculitis Rituximab Tumor necrosis factor inhibitors

Anmerkungen:	© The Author(s) 2023

doi:	10.1186/s12882-023-03439-0

funding:
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PPN (Katalog-ID):	SPR054146895