A phase II, single-arm multicenter study of low-dose rituximab for refractory mixed cryoglobulinemia secondary to hepatitis C virus infection

Rituximab-based novel strategies for the treatment of immune-mediated glomerular diseases

“…Glomerulonephritis responded within the first three months of treatment. Skin ulcers usually improved within three months after the beginning of RTX therapy, but complete healing required a longer time [37], [38] and [40]. Both sensory and motor neuropathy improved 1-5 months after RTX [38], [40], [41] and [51].…”

“…Encouraging results have been obtained in open-label studies and single case reports. RTX improves or cures various clinical manifestations of MC, including fatigue, purpura and skin ulcers, arthralgias and arthritis, glomerulonephritis (in about 90% of cases), peripheral neuropathy (in about 75% of cases), and hyperviscosity syndrome [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50] and [51]. RTX was also reported to be effective in some life-threatening cases of gastrointestinal vasculitis [43].…”

“…Skin ulcers usually improved within three months after the beginning of RTX therapy, but complete healing required a longer time [37], [38] and [40]. Both sensory and motor neuropathy improved 1-5 months after RTX [38], [40], [41] and [51]. Interestingly, RTX therapy exerted a steroid-sparing effect on MC [37], and some patients, including cases with active nephritis, were treated ab initio without steroids [39].…”

“…A proposed strategy, in an attempt to delay the relapses, is to administer two more infusions of RTX 1 and 2 months after the standard four week course (4 plus 2 infusion protocol) [39]. Re-treatment with RTX at disease relapse again proved to be effective in most cases [37], [40] and [43] . Maintenance therapy with RTX is rarely reported in MC, and may be taken into consideration in patients with severe chronic nephritic syndrome or abdominal vasculitis.…”

The case for cost‐effectively treating cryoglobulinemic vasculitis with interferon‐free anti–hepatitis C virus therapy

“…1 Interferon-ineligible/intolerant/nonresponder patients with severe organ damage require salvage treatments with rituximab (RTX) or plasma exchange; however, these treatments are expensive and provide only temporary benefit. 1,2 Both the American Association for the Study of Liver Diseases (http://www.hcvguidelines.org/full-report/when-and-whom-initiatehcv-therapy) and the European Association for the Study of the Liver (http://www.easl.eu/_newsroom/latest-news/easl-recommendations-on-treatment-of-hepatitis-c-2014) recommend prioritizing anti-HCV treatment in patients with MC vasculitis, but the impact of the severity of vasculitis on indication for early treatment is not thoroughly addressed.…”