Which agent is safe, most effective for treating cutaneous polyarteritis nodosa?

Use of colchicine provides a good balance between benefit and risk in patients with cutaneous polyarteritis nodosa without peripheral sensory neuropathy, reports a study. In the event of relapse, the best treatment appears to be the combination of glucocorticoids and azathioprine.

A team of investigators performed a multicentre, retrospective, observational study to describe the efficacy and safety of various treatments in patients with cutaneous polyarteritis nodosa, a form of medium-sized vessel vasculitis.

The team recorded both clinical and biological data along with treatments received. The rate of complete response at 3 months was the primary outcome, while drug survival and safety were secondary ones.

Sixty-eight patients who received a median of two therapeutic lines (interquartile range, 1‒3) participated in the study. Thirteen of 42 (31 percent) patients with colchicine, four of 17 (23 percent) with dapsone, 11 of 25 (44 percent) with glucocorticoids alone, one of nine (11 percent) with nonsteroidal anti-inflammatory drugs, 11 of 13 (84 percent) with glucocorticoids plus azathioprine, and seven of 15 (47 percent) with glucocorticoids plus methotrexate achieved a complete response.

Glucocorticoids plus azathioprine demonstrated the best drug survival with a median duration of 29.5 months (interquartile range, 19.5‒36.0).

Peripheral neurologic involvement led to a decrease in response at 3 months (odds ratio, 0.19, 95 percent confidence interval, 0.03‒0.81; p=0.04). The overall rate of treatment-related adverse events was 18 percent, which resulted in treatment discontinuation in 7 percent of patients.

This study was limited by its retrospective design, according to the investigators.