Treatment with peg-interferon alfa-2b and ribavirin of hepatitis C virus-associated mixed cryoglobulinemia: a pilot study

Mazzaro, Cesare; Zorat, Francesca; Caizzi, Manuela; Donada, Carlo; Gennaro, Gisella; Maso, Luigino Dal; Carniello, G. S.; Virgolini, Luigi; Tirelli, Umberto; Pozzato, Gabriele

doi:10.1016/j.jhep.2004.10.031

Cited by 121 publications

(67 citation statements)

References 38 publications

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“…SVR rates of 44% to 78% have been achieved with PEG IFN and ribavirin in small series of patients (56)(57)(58). SVR was associated with clinical improvement of the vasculitis in the majority of, but not all, patients (59).…”

Section: Cryoglobulinemiamentioning

confidence: 99%

Management of Chronic Hepatitis C: Consensus Guidelines

Sherman

Shafran

Burak

et al. 2007

Canadian Journal of Gastroenterology

101

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Since the last consensus conference on the management of chronic viral hepatitis, a number of studies looking at modifications of the standard course of treatment have been published. These changes have been sufficiently substantive to warrant review to determine whether any changes in the recommended treatment algorithms are needed. A consensus development conference was held in January 2007, and the present document highlights the results of the presentations and discussion about these issues. It reviews the epidemiology of hepatitis C in Canada, treatment of acute hepatitis C and new algorithms in chronic hepatitis C, including retreatment of previous treatment failures. In addition, sections on management of hepatitis C in special populations have been updated. There is also a section on the use of hematopoietic growth factors to help manage patients on therapy. The document should be read in conjunction with the previous document to identify changes. Some recommendations made in the previous document remain and are not discussed here.

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Section: Cryoglobulinemiamentioning

confidence: 99%

Management of Chronic Hepatitis C: Consensus Guidelines

Sherman

Shafran

Burak

et al. 2007

Canadian Journal of Gastroenterology

101

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“…The new direct acting antiviral drugs for HCV are being investigated in HCV-related CV. Importantly, antiviral treatment is presently not the first choice, based on clinical priorities, in HCV-positive patients with severe CV organ involvement [3], [4], [5], [6], [7] and [8]. Rituximab (RTX) is an anti CD20 monoclonal antibody, which depletes the expanded population of B cells, and proved to be an effective strategy in CV.…”

Section: Introductionmentioning

confidence: 99%

Retreatment regimen of rituximab monotherapy given at the relapse of severe HCV-related cryoglobulinemic vasculitis: Long-term follow up data of a randomized controlled multicentre study

Quartuccio

Zuliani

Corazza

et al. 2015

Journal of Autoimmunity

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ObjectiveTo evaluate the efficacy and safety in the long term of a retreatment regimen with Rituximab (RTX) alone administered at clinical relapse in cryoglobulinemic vasculitis (CV). Methods Thirty patients with severe HCV-related CV, previously enrolled in the multicentre Italian trial on RTX in the treatment of CV, were retrospectively evaluated after the end of the trial. All of them were managed with RTX alone at clinical relapse, if any. Disease activity at the last available follow up was defined as complete remission (absence of active disease), partial remission (response > 50% of at least one manifestation among glomerulonephritis, peripheral neuropathy or skin ulcers) or active disease. ResultsThe mean follow up after the first RTX cycle was 72.6 (20.4) months. After the end of the trial, 21/30 (70%) patients showed an active follow up [81.7 (10.9) months)], 3/30 (10%) lost follow up and 6/30 (20%) died. 12/21 (57.1%) patients were in complete disease remission, 5/21 (23.8%) showed a partial response and 4/21 (19%) had an active disease. 17/30 (56.7%) patients needed retreatment for relapse with a mean time to retreatment of 22.3 (12.1) months. Treatment survival of this regimen was 7.6 (0.3) years. Recurrent non-severe infections occurred in 3/30, with chronic hypogammaglobulinemia in 2/3 patients. Conclusions A long-term regimen of retreatment with RTX alone given at clinical relapse seems to be effective and safe in CV, with a low rate of infections and severe hypogammaglobulinemia. IntroductionCryoglobulinemic vasculitis (CV) is a systemic vasculitis, usually triggered by HCV infection [1], and characterized by an expansion of oligo-monoclonal B cells that produce IgM with rheumatoid factor (RF) activity, which can lead to the formation of immune complexes consisting of RF, HCV and polyclonal HCVspecific IgG, precipitating in blood vessel walls or glomerular capillaries. CV is characterized by the typical clinical triad of purpura, weakness, and arthralgia and often by severe organ involvement including glomerulonephritis, peripheral neuropathy, and skin ulcer [2]. Treatment of HCV-related CV may target either the viral trigger or the downstream B cell arm of autoimmunity. Anti-viral therapy has a strong rationale, is effective in many milder cases, but it may also prove ineffective, contraindicated, or not tolerated, and sometimes may worsen CV. The new direct acting antiviral drugs for HCV are being investigated in HCV-related CV. Importantly, antiviral treatment is presently not the first choice, based on clinical priorities, in HCV-positive patients with severe CV organ involvement [3], [4], [5], [6], [7] and [8]. Rituximab (RTX) is an anti CD20 monoclonal antibody, which depletes the expanded population of B cells, and proved to be an effective strategy in CV. Recently, two independent controlled randomized trials reported a large efficacy and good safety of RTX in severe manifestations of CV [9] and [10]. In the Italian study, 59 patients with severe manifestations of CV (skin ulcer...

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“…A suitable treatment regimen usually depends on renal function. A combination of interferon α, pegylated interferon and ribavirin is recommended (56)(57)(58)(59). Therapy recommended by the European League Against Rheumatism for patients presenting with normal renal function consists of a combination of pegylated interferon and ribavirin; however, for patients with renal insufficiency, monotherapy with interferon α is indicated since ribavirin is generally contraindicated in renal insuffiency (60).…”

Section: Treatmentmentioning

confidence: 99%

Cryoglobulinemia (Review)

Takada

Shimizu²,

Hadano³

et al. 2012

Mol Med Report

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Abstract.Cryoglobulins are immunoglobulins that precipitate at low temperatures and redissolve upon rewarming. Cryoglobulinemia refers to the presence of circulating cryoglobulins in serum, and generally leads to a systemic inflammatory syndrome characterized by fatigue, arthralgia, purpura, neuropathy and glomerulonephritis. The disease mainly involves small to medium-sized blood vessels and causes vasculitis due to cryoglobulin-containing immune complexes. Cryoglobulinemia is classified into three types (I, II and III) on the basis of immunoglobulin composition. Predisposing conditions include lymphoproliferative disease, collagen disease and hepatitis C virus (HCV) infection. The diagnosis of cryoglobulinemic syndrome is predominantly based on the laboratory demonstration of serum cryoglobulins. Treatment is often directed towards the underlying disease state. For patients with chronic HCV infection, anti-viral therapy is indicated. Intense immunosuppressive or immunomodulatory therapy, including steroids, plasmapheresis and cytotoxic agents, is reserved for organ-threatening or recalcitrant disease. In this review, we discuss the clinical characteristics of the three types of cryoglobulinemia.

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Treatment with peg-interferon alfa-2b and ribavirin of hepatitis C virus-associated mixed cryoglobulinemia: a pilot study

Cited by 121 publications

References 38 publications

Management of Chronic Hepatitis C: Consensus Guidelines

Management of Chronic Hepatitis C: Consensus Guidelines

Retreatment regimen of rituximab monotherapy given at the relapse of severe HCV-related cryoglobulinemic vasculitis: Long-term follow up data of a randomized controlled multicentre study

Cryoglobulinemia (Review)

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