Alpha interferon in the treatment of mixed cryoglobulinaemia patients

Ferri, Clodoveo; Marzo, E; Longombardo, G.; Lombardini, Fabrizio; Greco, Francesco; Bombardieri, Stefano

doi:10.1016/0277-5379(91)90583-y

Cited by 34 publications

(9 citation statements)

References 4 publications

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“…The mixed cryoglobulinemia syndrome (MCS) or symptomatic mixed cryoglobulinemia is defined by the Meltzer and Franklin triad of purpura, fatigue and arthralgia [3], and can be classified as one of the immune complex-mediated systemic vasculitides involving small-sized vessels. Since the discovery of hepatitis C virus (HCV), it has been shown that the vast majority of MCs previously defined as 'essential' or idiopathic can be attributed to it [4][5][6][7]. Circulating cryoglobulins are frequently detected in HCV-positive patients, but only a minority of patients with chronic HCV infections (usually women aged more than 50 years) develop frank MCS [8].…”

Section: Introductionmentioning

confidence: 99%

Recommendations for the management of mixed cryoglobulinemia syndrome in hepatitis C virus-infected patients

Pietrogrande¹,

Vita²,

Zignego³

et al. 2011

Autoimmunity Reviews

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Objective: The objective of this review was to define a core set of recommendations for the treatment of HCVassociated mixed cryoglobulinemia syndrome (MCS) by combining current evidence from clinical trials and expert opinion. Methods: Expert physicians involved in studying and treating patients with MCS formulated statements after discussing the published data. Their attitudes to treatment approaches (particularly those insufficiently supported by published data) were collected before the consensus conference by means of a questionnaire, and were considered when formulating the statements. Results: An attempt at viral eradication using pegylated interferon plus ribavirin should be considered the first-line therapeutic option in patients with mild-moderate HCV-related MCS. Prolonged treatment (up to 72 weeks) may be considered in the case of virological non-responders showing clinical and laboratory improvements. Rituximab (RTX) should be considered in patients with severe vasculitis and/or skin ulcers, peripheral neuropathy or glomerulonephritis. High-dose pulsed glucocorticoid (GC) therapy is useful in severe conditions and, when necessary, can be considered in combination with RTX; on the contrary, the majority of conference participants discouraged the chronic use of low-medium GC doses. Apheresis remains the elective treatment for severe, life-threatening hyper-viscosity syndrome; its use should be limited to patients who do not respond to (or who are ineligible for) other treatments, and emergency situations. Cyclophosphamide can be considered in combination with apheresis, but the data supporting its use are scarce. Despite the limited available data, colchicine is used by many of the conference participants, particularly in patients with mild-moderate MCS refractory to other therapies. Careful monitoring of the side effects of each drug, and its effects on HCV replication and liver function tests is essential. A lowantigencontent diet can be considered as supportive treatment in all symptomatic MCS patients. Although there are no data from controlled trials, controlling pain should always be attempted by tailoring the treatment to individual patients on the basis of the guidelines used in other vasculitides. Conclusion: Although there are few controlled randomised trials of MCS treatment, increasing knowledge of its pathogenesis is opening up new frontiers. The recommendations provided may be useful as provisional guidelines for the management of MCS.

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Section: Introductionmentioning

confidence: 99%

Recommendations for the management of mixed cryoglobulinemia syndrome in hepatitis C virus-infected patients

Pietrogrande¹,

Vita²,

Zignego³

et al. 2011

Autoimmunity Reviews

Self Cite

186

155

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“…ported by Pascual et al [6] in 3/10 and by Ferri et al [7] in 12/22 MC patients. Not long after, a high incidence of anti-HCV antibody seropositivity was detected in a large number of unsclccted MC patients uti lizing enzyme-linked immunosorbent and immunoblot assay techniques [8], Moreover, HCV seropositivity was associated with the presence of HCV genome in a high percent age of cases [9], In our previous study, the prevalence of HCV was similar in the sub sets of MC patients with cither chronic hepa titis or membranoproliferative glomerulone phritis (MPGN).…”

Section: Membranoproliferative Glomerulonephritis Associated With Hepmentioning

confidence: 99%

Cryoglobulinemia Membranoproliferative Glomerulonephritis Associated with Hepatitis C Virus

et al. 1993

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A striking association between hepatitis C virus (HCV) and mixed cryoglobulinemia (MC) has been reported by various authors, regardless of the presence of chronic hepatitis. The aim of this study is to evaluate the prevalence of HCV-related markers in cryoglobulinemic membranoproliferative glomerulonephritis (MPGN) which is one of the most severe complications of MC. Antibodies against HCV have been detected by second-generation Chiron ELISA and RIBA in 26/26 (100%) cryoglobulinemic MPGN. In addition, serum HCV RNA, expression of the ongoing viral replication, was present in 7/7 patients by the polymerase chain reaction technique. The high percentage of anti-HCV seropositivity suggests that this virus may play an important role in the pathogenesis of this immunemediated glomerulonephritis.

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“…However, recently two studies on a large series of Italian patients have reported an association between HCV and AI-CAH [63] and the responsiveness of both to alfa-interferon treatment [60], similar to what has been observed for MC [21,39,56,57,58]. Moreover, in a significant number of our MC patients different autoantibodies, including the HCV-related auto-antibody anti-GOR [64], have been detected [49]; similarly, mixed cryoglobulins with R F activity and hypocomplementaemia, typical hallmarks of MC, have been found in a fair number of patients with AI-CAH [49,65].…”

Section: Hcv MC and Chronic Liver Diseasesmentioning

confidence: 87%

“…On the other hand, positive effects of alfa-interferon on various symptoms of MC, in particular cryoglobulinaemic hepatitis, have been reported [21,56,57,58]. The efficacy of alfa-interferon in these patients may represent indirect evidence of a viral etiology for MC.…”

Section: Hcv MC and Chronic Liver Diseasesmentioning

confidence: 99%

“…In 1990 a possible pathogenetic role of HCV in MC patients first emerged from a number of preliminary observations [20,21]; using first generation tests, antibodies against HCV were demonstrated in 3/10 (30%) and 12/22 (54'%) of MC patients, respectively (Table I). These findings were confirmed in a subsequent study on a larger series of 40 MC patients, in whom HCVAb were detected in 55% of the cases, while they were present in only 1.2% of the healthy controls and were entirely absent in 55 patients with other systemic immunologic disorders [22].…”

Section: Mixed Cryoglobulinaemia and Hepatitis C Virusmentioning

confidence: 99%

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