Prospective study of guideline‐tailored therapy with direct‐acting antivirals for hepatitis C virus‐associated mixed cryoglobulinemia

Gragnani, Laura; Visentini, Marcella; Fognani, Elisa; Urraro, Teresa; Santis, Adriano De; Petraccia, Luisa; Perez, Marie; Ceccotti, Giorgia; Colantuono, Stefania; Mitrevski, Milica; Stasi, Cristina; Padre, Martina Del; Monti, Monica; Gianni, Elena; Pulsoni, Alessandro; Fiorilli, Massimo; Casato, Milvia; Zignego, Anna Linda

doi:10.1002/hep.28753

Cited by 181 publications

(199 citation statements)

References 50 publications

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“…Sustained virological response is the main goal in these patients since clinical remission of vasculitis is closely associated with viral clearance 8 . Few studies have reported promising results on the effectiveness and tolerance of direct acting antiviral drugs (DAA), either in association with interferon (IFN) or using IFN-free regimens [8][9][10][11] . The aim of the present study was to evaluate effectiveness and tolerance of an all oral IFN-and ribavirin-free regimen with sofosbuvir plus daclatasvir in patients with cryoglobulinemia vasculitis.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Sofosbuvir Plus Daclatasvir for Treatment of HCV-Associated Cryoglobulinemia Vasculitis

et al. 2017

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Section: Introductionmentioning

confidence: 99%

“…Median time to achieve a clinical response was twelve weeks. forty four patients treated by sofosbuvir based IFN-free regimen which included ribavirin in twenty eight patients 9 . All patients were virological responders and 93% improved M A N U S C R I P T Clearance of cryoglobulin is an important goal of the treatment of HCV-CryoVas.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Sofosbuvir Plus Daclatasvir for Treatment of HCV-Associated Cryoglobulinemia Vasculitis

et al. 2017

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“…For at least some patients with severe cryoglobulinemia achievement of SVR may be insuffi cient to complete mitigate its manifestations, and additional support with rituximab and/or plasmapheresis may still be required. However, this report and others indicate that inferior SVR rates in HCV patients with cryoglobulinemia have been overcome with DAA therapy ( 8,9 ), and that clinical improvement, although not inevitable, typically follows. Th e enhanced effi cacy of DAA has simplifi ed management of this important manifestation of HCV infection.…”

mentioning

confidence: 66%

Editorial: Benefit of Direct-Acting Antiviral Therapy For Cryoglobulinemia due to Hepatitis C Infection

Martin

Fabrizi

2017

American Journal of Gastroenterology

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Extrahepatic consequences of hepatitis C infection are increasingly recognized as a source of additional morbidity distinct from the consequences of liver disease. Among the best characterized of these is mixed cryoglobulinemia, which can lead to a variety of disorders, including vasculitis and glomerulonephritis. In general, the results of antiviral therapy in the interferon era had been disappointing, but now with new all-oral regimens response rates are substantially better. However, even with successful clearance of the virus symptomatic response can lag. Am J Gastroenterol 2017; 112:1309-1310 doi: 10.1038/ajg.2017 Infection with the hepatitis C virus (HCV) has been implicated in a variety of adverse extrahepatic consequences, with its role convincingly established in the pathogenesis of mixed cryoglobulinemia syndrome (MCS), in which underlying HCV infection is almost always present ( 1 ). Th is phenomenon refl ects the presence of circulating immunoglobulins, which precipitate when serum is cooled below body temperature and dissolve when heated to 37 °C. Th ree types of cryoglobulins are recognized. Type I, a single monoclonal immunoglobulin, occurs with B-cell lymphoproliferative disorders. In contrast, HCV-associated MCS is due to type II cryoglobulins, which include a polyclonal immunoglobulin, IgG, and a monoclonal immunoglobulin, IgM, with rheumatoid factor activity. Type III is a polyclonal IgM, which again occurs with rheumatoid activity. Despite detection of circulating cryoglobulins in a large number of HCV-infected patients, only a minority experience major clinical manifestations ( 2 ), which include vasculitis, palpable purpura, and glomerulo nephritis. Other symptoms of mixed cryoglobulinemia include fatigue, arthralgia, and neuropathy. Severe vasculitis and advanced-stage fi brosis are implicated in worse prognosis in patients with HCV-related MCS ( 3 ), whereas successful anti viral therapy for HCV improves prognosis. Other interventions for HCV-related MCS have included plasmapheresis and rituximab ( 4 ), which can provide temporary control of symptoms, but with a high rate of relapse.In the current issue, Emery and colleagues report their experience with use of direct-acting antivirals (DAAs) in HCVinfected patients with cryoglobulinemia ( 5 ). Th e patients were treated between 2011 and 2015 with specifi c antiviral regimens chosen by the treating physician, and as a result some patients received interferon-based therapy combined with a DAA rather than an all-oral regimen. Of the 83 treated patients 18 had symptomatic cryoglobulinemia, and of these two-thirds had cirrhosis. Sustained virological response rates were 88.9% and 90.8% in symptomatic and asymptomatic patients, respectively, with a trend towards higher SVR rates with interferon-free regimens. In contrast to earlier reports with purely interferon-based therapy, the presence of cryoglobulinemia did not reduce SVR ( 6 ). Despite the impressive SVR achieved in the symptomatic patients, however, clinical improvement was no...

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“…The available data suggest that IFN-free regimens are safe, generally well-tolerated, and effective in MC patients [140][141][142][143]. In the IFN era, rituximab was administered mostly to patients who had failed or were not eligible for antiviral therapy, even if a rituximab plus antiviral combination was suggested for patients with severe manifestations (generally using rituximab before antiviral therapy) [132,[144][145][146].…”

Section: Extrahepatic Manifestations Of Hcv: Mixed Cryoglobulinemiamentioning

confidence: 99%

Current and future challenges in HCV: insights from an Italian experts panel

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Prospective study of guideline‐tailored therapy with direct‐acting antivirals for hepatitis C virus‐associated mixed cryoglobulinemia

Cited by 181 publications

References 50 publications

Efficacy and Safety of Sofosbuvir Plus Daclatasvir for Treatment of HCV-Associated Cryoglobulinemia Vasculitis

Efficacy and Safety of Sofosbuvir Plus Daclatasvir for Treatment of HCV-Associated Cryoglobulinemia Vasculitis

Editorial: Benefit of Direct-Acting Antiviral Therapy For Cryoglobulinemia due to Hepatitis C Infection

Current and future challenges in HCV: insights from an Italian experts panel

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