Triple antiviral therapy in hepatitis C virus infection with or without mixed cryoglobulinaemia: A prospective, controlled pilot study

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

“…Peg-IFN plus ribavirin plus boceprevir or telaprevir administered to 30 MC patients resulted in 67% of complete clinical and virological response, while 47% of patients had severe side effects [136]. Another study confirmed the good efficacy of this combination in 22 MC patients, and cryoglobulinemia resolution in 86% of cases, but a lower SVR rate in cryoglobulinemic patients than in patients without MC (23.8 vs 70%, p = 0.01) [137]. In a small case series of MC patients treated with peg-IFN plus ribavirin plus sofosbuvir or first generation DAAs, longer treatment for cirrhotic patients was suggested [138,139].…”

Extrahepatic Manifestations of Hepatitis C Virus

“…37 In another prospective study, 35 genotype-1-infected patients with MC who received a 48 weeks' course of Peg-IFN/Rbv plus boceprevir experienced a significant reduction of cryocrit values and an improvement in symptoms; however, they achieved lower SVR rates compared with matched MC-free controls (24% vs 70%; P 5 .01). 36 Although neither efficacy nor safety data are available for the treatment of HCV-related MC with all oral regimens based on new direct-acting antiviral agents (DAA), high SVR rates and excellent safety and tolerability records can be anticipated with those regimens. 1 However, the demonstration that HCV suppression following direct antiviral therapy restores NK cell function related innate immunity should alert against the clinical risks of immune reconstitution that might also ensue in patients with MCS following exposure to all oral DAA.…”

“…While cumulatively the achievement of a sustained virological response (SVR) to interferon-based therapy has resulted in the recovery from signs and symptoms of MCS in up to 90% of patients, access to interferon therapy was restricted in most patients with advanced hepatitis owing to an increased risk of life-threatening adverse reactions to interferons or myelosuppression. [32][33][34][35][36][37][38] Regrettably, for interferon-ineligible patients, symptomatic treatment of the clinical manifestations of MC without suppressing HCV leads to a transient control of the clinical syndrome only. Thus, virus eradication should be attempted as a firstline therapeutic option in patients with HCV infection with MCS, although either onset or worsening of vasculitic manifestations such as peripheral neuropathy, nephropathy, and skin ulcers have occasionally been reported after administration of interferon.…”

Where Do we Go from here

“…Or when the cure of patients with mixed cryoglobulinemia was a dream. Now the association with Hepatitis C is confirmed and we have witnessed the dramatic cure of patients with decades of disease using newer antivirals [3].…”

“…Or when the cure of patients with mixed cryoglobulinemia was a dream. Now the association with Hepatitis C is confirmed and we have witnessed the dramatic cure of patients with decades of disease using newer antivirals [3].Unfortunately, these are isolated victories in a war that we are just beginning to fight. For Giant Cell Arteritis and its non arteritic companion polymyalgia rheumatica we are just beginning to develop steroid sparing therapy.…”