Safety and efficacy of rituximab in patients with hepatitis C virus–related mixed cryoglobulinemia and severe liver disease

Abstract

The effectiveness of rituximab in hepatitis C virus (HCV)-related mixed cryoglobulinemia (MC) has been shown. However, the risk of an increase in viral replication limits its use in cirrhosis, a condition frequently observed in patients with MC. In this prospective study, 19 HCV-positive patients with MC and advanced liver disease, who were excluded from antiviral therapy, were treated with rituximab and followed for 6 months. MC symptoms included purpura, arthralgias, weakness, sensory-motor polyneuropathy, nephropathy, and leg ulcers.

Genetic determinants in hepatitis C virus–associated mixed cryoglobulinemia: Role of polymorphic variants of BAFF promoter and Fcγ receptors

“…The 21 patients who underwent rituximab therapy were administered 4 weekly injections of 375 mg/m 2 and followed up as previously described (9). Overall, a complete clinical response was defined as improvement in all baseline clinical MC manifestations, while a partial response was defined as improvement in at least half of the baseline clinical symptoms.…”

“…Overall, a complete clinical response was defined as improvement in all baseline clinical MC manifestations, while a partial response was defined as improvement in at least half of the baseline clinical symptoms. All other patients were classified as clinical nonresponders (9).…”

Treatment with rituximab in patients with mixed cryoglobulinemia syndrome: Results of multicenter cohort study and review of the literature

“…Review papers were excluded. A total of 39 manuscripts that reported on at least one case of cryoglobulinemic vasculitis treated with rituximab were included in the present analysis [9][10][11][12][24][25][26][27][28][29][30][31]. Three manuscripts were excluded because they included patients that had already been described in other publications [9,11,37].…”

“…The safety and efficacy of this drug have been reported in various vasculitides and other systemic autoimmune diseases [13][14][15][16][17][18][19][20][21][22][23]. The usefulness of monoclonal antibodies directed to CD20 antigen, a trans membrane protein expressed on pre-B lymphocytes and mature B lymphocytes, on both cutaneous and visceral organ involvement of MCs, including low grade B-cell lymphoma, has been reported by various Authors, generally referred to small patients' series [24][25][26][27][28][29][30][31]. These are often characterized by a heterogeneous composition of clinical manifestations that does not permit an accurate evaluation of the effect of rituximab on single organ involvement.…”

Treatment of rheumatoid arthritis in patients with concomitant chronic hepatitis C infection

“…Petrarca and colleagues used rituximab to treat HCVassociated cryoglobulinemia in 19 patients with severe liver disease, 15 of whom had cirrhosis [Petrarca et al 2010]. No worsening of liver disease was noted.…”