Clin Exp Pediatr.  2020 May;63(5):158-163. 10.3345/kjp.2019.00514.

Treatment of refractory IgA vasculitis with dapsone: a systematic review

• Lee KH
• Hong SH
• Jun J
• Jo Y
• Jo W
• Choi D
• Joo J
• Jung G
• Ahn S
• Kronbichler A
• Eisenhut M
• Shin JI

• KMID: 2502884
• DOI: http://doi.org/10.3345/kjp.2019.00514

Abstract

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.

Keyword

IgA vasculitis; Henoch-Schonlein purpura; Dapsone; Systematic review