Efficacy of Anti-TNF-α Inhibitors for Refractory Leg Ulcers in Cutaneous Polyarteritis Nodosa: A Case Series.

Abstract

OBJECTIVE Cutaneous polyarteritis nodosa (cPAN) is a rare necrotizing vasculitis that primarily affects small-to-medium-sized arteries in subcutaneous tissue. cPAN is often characterized by a chronic and relapsing disease that presents with skin ulcers, livedo, and painful erythema. In this study, we evaluated the efficacy of anti-TNF-α inhibitor treatment for cPAN-associated refractory leg ulcers. METHODS This retrospective study was conducted between 2016 and 2023 at three medical institutions in Japan and targeted patients with cPAN presenting with refractory leg ulcers who were treated with anti-TNF-α inhibitors. The diagnosis of cPAN was histologically confirmed, and patients with secondary PAN were excluded. Data on the clinical background, treatments, ulcer status, and glucocorticoid dosages were collected, and the therapeutic efficacy of the treatment was evaluated. RESULTS Ten patients were included, with a mean age of 51 years, and nine were female. All patients presented with recurrent leg ulcers. Anti-TNF-α inhibitors included adalimumab (five cases), etanercept (four cases), and infliximab (one case). Complete epithelialization of the leg ulcers was achieved in all patients, and the average glucocorticoid dose was successfully reduced from 20 mg/day to 3.5 mg/day. Additionally, five patients achieved a glucocorticoid-free status. No serious adverse events were observed in any of the patients. CONCLUSION Anti-TNF-α inhibitors suggested therapeutic efficacy for cPAN-associated refractory leg ulcers and enabled ulcer epithelialization and significant glucocorticoid dose reduction. These findings support the utility of anti-TNF-α inhibitors in the management of refractory leg ulcers in cPAN, highlighting the need for further large-scale studies to validate the results.