Role of ribavirin in the treatment of hepatitis C virus-associated mixed cryoglobulinemia with interferon-free regimens

Abstract

Mixed cryoglobulinemia (MC) is the most common extrahepatic manifestation of chronic hepatitis C (CHC), with the presence of symptoms in 10-15% of cases. There have been encouraging data regarding immunological and clinical responses in patients treated with the novel combinations of direct-acting antivirals (DAAs), but the role of ribavirin (RBV) in the treatment of MC has not yet been demonstrated. We prospectively enrolled 132 patients affected by MC and CHC, and virological, immunological and clinical responses were evaluated at 12 weeks after completion of treatment. All subjects were treated with interferon (IFN)-free regimens according to clinical guidelines, with or without RBV. All patients achieved a virological response. A complete immunological response (CR) was observed in 71 subjects (53.8%), a partial response in 44 (33.3%), and no response in 17 (12.8%). Ten patients showed a complete resolution of symptoms (7.6%), and 31 showed a significant improvement (23.5%). CR was significantly higher in patients taking RBV (71.1 vs. 44.8%, p < 0.001) and in treatment-naïve patients (62.5 vs. 43.3%, p < 0.001). In logistic regression analysis, duration of HCV infection of less than 20 years (OR 2.448; 95% IC 1.335-6.202; p = 0.019), treatment-naïve status (OR 2.885; 95% IC 1.404-9.660; p = 0.025) and the use of RBV (OR 6.961; 95% IC 3.912-26.885; p < 0.001) were predictors of CR. In MC patients, IFN-free regimens are effective and well tolerated, and RBV seems to significantly increase the immunological response and promote a decline in cryocrit.

Sofosbuvir&ndash;daclatasvir improves hepatitis C virus&ndash;induced mixed cryoglobulinemia: Upper Egypt experience

“…11 Our findings revealed significantly higher RF with significantly lower C3 and C4 serum levels among the included HCV-MC in comparison with the controls, with significant improvements in their level following DAAs. In line with our data, Boglione et al 14 and Gragnani et al 37 reported similar findings.…”

“…Before the advent of direct-acting antivirals (DAAs), interferon (IFN)-based regimens produced clinical recovery with subsequent improvement of MC as a result of HCV clearance; however, the side effects of IFN may mimic the MC manifestations, and the relapse rate with IFN-based regimens was high. 13 Boglione et al 14 reported a study on the treatment of HCV-MC with IFN-free regimens, with or without ribavirin, and concluded that IFN-free regimens were effective and well tolerated in treating HCV-MC and significantly promoted a decrease in cryoglobulins.…”