Successful treatment of hepatitis B‐associated vasculitis using lamivudine as the sole therapeutic agent

Filer, Andrew; Hughes, Andrew; Kane, Kathleen; Mutimer, D.J.; Jobanputra, Paresh

doi:10.1093/rheumatology/40.9.1064

Cited by 15 publications

(13 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similarly to HCV-positive MC [13], some evidence in the scientific literature exists on the treatment of HBV-induced cryoglobulinemic vasculitis with targeted strategies. Antiviral treatment, mostly based on mono-therapy with NUCs such as lamivudine [4,5,6,9], adefovir dipivoxil [7], entecavir [8], or telbivudine [10] has given encouraging results in terms of viral clearance and clinical remission in HBV-associated cryoglobulinemic vasculitis (Table 2). Moreover, NUCs have been also administered with some benefit for HBV-associated nephropathy [14,15].…”

Section: Review Of the Literaturementioning

confidence: 99%

“…Immunosuppressive therapies, by virtue of their mechanisms of action, have the potential to have a permissive effect on HBV replication resulting in an accelerated liver injury and worsening of extra-hepatic complications including vasculitis. On the other hand, evidence on antiviral treatment with nucleos(t)ide analogues (NUCs) is extremely limited [4,5,6,7,8,9,10,11]. …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

HBV-Associated Cryoglobulinemic Vasculitis: Remission after Antiviral Therapy with Entecavir

Viganò

Martin

Cappelletti

et al. 2014

Kidney Blood Press Res

View full text Add to dashboard Cite

Background/Aims: Cryoglobulinemic vasculitis remains an uncommon complication of hepatitis B virus infection. Methods: We report the case of a 40-years old female Chinese patient with chronic hepatitis B developing cryoglobulinemic vasculitis with multiple organ involvement (liver, kidney, and skin) coupled with weakness, arthralgias, haemolytic anaemia, and autoimmune thyroiditis. She received entecavir mono-therapy at dose adjusted for estimated glomerular filtration rate. Results: Within five months of entecavir treatment, hepatitis B viraemia decreased below the limit of detection with normal serum amino-transferase levels, HBeAg clearance occurred, vasculitis regressed with disappearance of purpura and ascites; in addition, renal function normalized and nephritic syndrome remitted. After a five-year follow-up, the patient is asymptomatic with intact kidney function, proteinuria in the normal range, and normal liver biochemistry, despite the antiviral treatment was withdrawn and the patient remained HBsAg positive. Conclusions: This is the second case of hepatitis B virus-related cryoglobulinemic vasculitis successfully treated with entecavir suggesting that effective antiviral therapy may counteract both the hepatic and extra-hepatic manifestations of infection by hepatitis B virus.

show abstract

Section: Review Of the Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

HBV-Associated Cryoglobulinemic Vasculitis: Remission after Antiviral Therapy with Entecavir

Viganò

Martin

Cappelletti

et al. 2014

Kidney Blood Press Res

View full text Add to dashboard Cite

show abstract

“…First, antiviral therapy that successfully inhibits HBV replication results in clinical and biochemical amelioration of HBV-associated PAN, even when given in the absence of immunosuppressive treatment (21,25,26). In addition, there are limited data to suggest that autoantibodies are associated with HBV-related extrahepatic syndromes.…”

mentioning

confidence: 99%

Hepatitis B Virus Replication in Damaged Endothelial Tissues of Patients with Extrahepatic Disease

Mason

Theal²,

Bain³

et al. 2005

Am J Gastroenterology

View full text Add to dashboard Cite

Hepatitis B virus (HBV) infection may be complicated by extrahepatic manifestations such as polyarteritis nodosa (PAN), glomerulonephritis, polymyositis, and dermatitis, but the etiology of these processes is not yet clear. HBV replication has been demonstrated in a variety of extrahepatic tissues and cell types, but the possible pathogenetic role of extrahepatic HBV replication has not been fully explored in patients with extrahepatic manifestations of HBV infection. In this case series, immunohistochemistry and in situ hybridization studies were performed on extrahepatic tissues from one HBsAg-positive patient with PAN and another HBsAg-positive patient with polymyositis, using HBsAg-seronegative control subjects with the same vasculitic disorders as controls. Tissue samples from the two study patients had detectable HBV RNA, replicative intermediates of HBV DNA, as well as HBsAg and HBcAg localized to vascular endothelium. In contrast, HBsAg-negative control patients had no tissue reactivity. Our results suggest that patients with HBV-related extrahepatic disease have evidence of viral replication in damaged extrahepatic endothelial tissues. While further studies would be required to support a hypothesis of causality, these findings suggest a role for both immune complex deposition and viral replication within diseased endothelial tissue in the pathogenesis of these poorly understood extrahepatic disorders.

show abstract

“…Antiviral therapy may successfully treat HBV-PAN by inhibiting viral replication, even without concomitant immunosuppressive treatment [29]. Guillevin et al proposed a stepwise strategy with initial prompt and rapid control of severe lifethreatening manifestations of the vasculitis using systemic glucocorticoid, and then plasmapheresis aimed at removing the ICs, followed by antiviral therapy to inhibit HBV replication and abrupt cessation of glucocorticoid after 1e2 weeks to enhance immunological clearance of HBV-infected hepatocytes and to facilitate seroconversion of HBeAg to anti-HBeAb [30].…”

Section: Treatmentmentioning

confidence: 99%

Vasculitis related to viral and other microbial agents

Teng

Chatham

2015

Best Practice & Research Clinical Rheumatology

View full text Add to dashboard Cite

Successful treatment of hepatitis B‐associated vasculitis using lamivudine as the sole therapeutic agent

Cited by 15 publications

References 8 publications

HBV-Associated Cryoglobulinemic Vasculitis: Remission after Antiviral Therapy with Entecavir

HBV-Associated Cryoglobulinemic Vasculitis: Remission after Antiviral Therapy with Entecavir

Hepatitis B Virus Replication in Damaged Endothelial Tissues of Patients with Extrahepatic Disease

Vasculitis related to viral and other microbial agents

Contact Info

Product

Resources

About