Efficacy and Safety of Direct Acting Antivirals for the Treatment of Mixed Cryoglobulinemia

Emery, Joel; Kuczynski, Magdalena; La, Danie; Almarzooqi, Saeed; Kowgier, Matthew; Shah, Hemant; Wong, David; Janssen, Harry L A; Feld, Jordan J.

doi:10.1038/ajg.2017.49

Cited by 97 publications

(93 citation statements)

References 39 publications

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“…Several centers have published their experience with novel DAA therapies in HCV‐MCS, including agents such as sofosbuvir, simeprevir, daclatasvir, ledipasvir, asunaprevir, dasabuvir, pariteprevir, and ombitasvir (Table ). Studies demonstrate that DAA regimens achieve SVR in 95% (297 out of 313) of patients with HCV‐MCS, which is similar to cure rates in the general population with HCV . There are currently no reports of HCV‐MCS treated with more recently approved DAAs, such as sofosbuvir/velpatasvir/voxilaprevir, elbasvir/grazoprevir, glecaprevir/pibrentasvir, or sofosbuvir/velpatasvir, but there is no reason to think that these agents would be less effective in HCV‐MCS.…”

Section: Direct‐acting Antiviral Treatment In Mixed Cryoglobulinemia mentioning

confidence: 95%

“…Others series using teleprevir or boceprevir report varying results, notably Gragnani et al treated five patients with HCV‐MCS with boceprevir‐based therapy, none of these patients achieved SVR, nor did any achieve a clinical response . Overall, telaprevir or boceprevir‐based therapies achieved SVR in 35/52 patients (67%), though these have now been replaced by newer, more effective IFN‐free DAA regimens which are much better tolerated …”

Section: Direct‐acting Antiviral Treatment In Mixed Cryoglobulinemia mentioning

confidence: 99%

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Treatment of hepatitis C virus infection in patients with mixed cryoglobulinemic syndrome and cryoglobulinemic glomerulonephritis

Rutledge

Chung

Sise

2018

Hemodialysis International

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Cryoglobulinemia is a common extrahepatic manifestation of infection with hepatitis C virus (HCV). When signs and symptoms of systemic vasculitis or glomerulonephritis occur in the presence of circulating cryoglobulins, this syndrome is called "mixed cryoglobulinemia syndrome" (MCS). Historically, interferon-based therapies in HCV have been associated with lower rates of viral cure in patients with MCS than in the general HCV-infected population. The advent of direct-acting antiviral therapies have revolutionized the treatment of HCV, dramatically increasing rates of cure. Early studies of first-generation protease inhibitors (telaprevir and boceprevir) in combination with interferon and ribavirin demonstrated HCV cure rates of 67% and complete clinical response rates of vasculitis symptoms in 60% of patients with MCS; however, regimens were poorly tolerated by patients, 22% discontinued treatment early. More recently, all-oral, interferon-free regimens have become available and combination therapies are now being approved for patients with and without renal impairment. Patients with HCV-MCS achieved sustained virologic response in 297 out of 313 patients (95%) treated with direct-acting antiviral therapy, and 85% had a complete or partial clinical response of MCS symptoms. Current direct-acting antiviral therapies are well tolerated in patients with HCV-MCS and only 1.6% discontinued treatment early. Patients with cryoglobulinemic glomerulonephritis also had an excellent cure rate (94%). The majority improved; 17/52 (33%) experienced full remission and 15/52 (29%) experienced partial remission. There were no reports of worsening kidney function in patients treated with direct-acting antiviral therapies. Less than 5% of patients with HCV-MCS treated with IFN-free direct-acting antiviral therapy required immunosuppression. However, patients with severe vasculitis appear to still require concomitant immunosuppression.

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Section: Direct‐acting Antiviral Treatment In Mixed Cryoglobulinemia mentioning

confidence: 95%

Section: Direct‐acting Antiviral Treatment In Mixed Cryoglobulinemia mentioning

confidence: 99%

Treatment of hepatitis C virus infection in patients with mixed cryoglobulinemic syndrome and cryoglobulinemic glomerulonephritis

Rutledge

Chung

Sise

2018

Hemodialysis International

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“…33 and those with extrahepatic manifestations of HCV infection. 34 Patients with mild fibrosis (F0-F2) should also be considered for treatment. Viral eradication in this group improves health related quality of life 8,9 and may prevent incident infections in those at risk of infecting others (e.g., people engaged in high risk activities).…”

Section: All Patients With Chronic Hcv Infection Should Be Consideredmentioning

confidence: 99%

The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver

Shah¹,

Bilodeau

Burak

et al. 2018

CMAJ

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“…Another possible explanation for the occurrence of cryoglobulinemia following SVR is the persistence of few copies of HCV-RNA in liver cell, macrophages, or lymphocytes. This leads to the persistent stimulation of the immune system and formation of cryoglobulins [16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Incidence and Characteristics of de novo Renal Cryoglobulinemia After Direct-Acting Antivirals Treatment in an Egyptian Hepatitis C Cohort

Nokeety

Abdelaziz

Samir

et al. 2018

Nephron

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Introduction: The side effects profile of the new direct-acting antivirals for the treatment of hepatitis C virus (HCV) is not fully elucidated. Objective: In this cross-sectional study, we aim to describe the incidence and characteristics of a novel observation of de novo renal cryoglobulinemic glomerulonephritis after successful treatment with DAA. Methodology: A total of 12,985 Hepatitis C Patients (genotype IV) received the new DAA. After successful treatment, patients with deranged renal functions or proteinuria were referred to the nephrology department for assessment. The clinical manifestations ranged from lower limb edema to the development of purpura skin lesions. Cryoglobulins were tested in the serum using the PCR detection. Results: Fifty patients had detectable de novo cryoglobulins in the serum. The most common type in renal biopsies was membranoproliferative glomerulonephritis (52%) and chronic kidney disease (CKD) developed in 46% of cases. Conclusion: De novo cryoglobulinemic glomerulonephritis and progression to CKD may rarely complicate successful treatment of HCV using direct-acting antivirals.

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Efficacy and Safety of Direct Acting Antivirals for the Treatment of Mixed Cryoglobulinemia

Cited by 97 publications

References 39 publications

Treatment of hepatitis C virus infection in patients with mixed cryoglobulinemic syndrome and cryoglobulinemic glomerulonephritis

Treatment of hepatitis C virus infection in patients with mixed cryoglobulinemic syndrome and cryoglobulinemic glomerulonephritis

The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver

Incidence and Characteristics of de novo Renal Cryoglobulinemia After Direct-Acting Antivirals Treatment in an Egyptian Hepatitis C Cohort

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