Virological and Clinical Response to Interferon-Free Regimens in Patients with HCV-Related Mixed Cryoglobulinemia: Preliminary Results of a Prospective Pilot Study

Gragnani, Laura; Piluso, A.; Urraro, Teresa; Fabbrizzi, Alessio; Fognani, Elisa; Petraccia, Luisa; Genovesi, A; Giubilei, L.; Ranieri, Jessica; Stasi, Cristina; Monti, Monica; Zignego, Anna Linda

doi:10.2174/1389450117666160208145432

Cited by 51 publications

(59 citation statements)

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“…50 Data on the use of DAAs in mixed cryoglobulinemia are emerging with encouraging results. [51][52][53][54] Rituximab was shown to be effective in HCV-associated cryoglobulinemia. In a prospective cohort study, the addition of rituximab to pegylated interferon-ribavirin resulted in a shorter time to response and better renal response and cryoglobulin clearance, although the rate and depth of clinical response and the relapse rate were similar between study arms.…”

Section: Case 4: Hcv-associated (Infectious) Mixed Cryoglobulinemiamentioning

confidence: 99%

How I treat cryoglobulinemia

Muchtar

Magen

Gertz

2017

Blood

136

146

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Cryoglobulinemia is a distinct entity characterized by the presence of cryoglobulins in the serum. Cryoglobulins differ in their composition, which has an impact on the clinical presentation and the underlying disease that triggers cryoglobulin formation. Cryoglobulinemia is categorized into two main subgroups: type I, which is seen exclusively in clonal hematologic diseases, and type II/III, which is called mixed cryoglobulinemia and is seen in hepatitis C virus infection and systemic diseases such as B-cell lineage hematologic malignancies and connective tissue disorders. Clinical presentation is broad and varies between types but includes arthralgia, purpura, skin ulcers, glomerulonephritis, and peripheral neuropathy. Life-threatening manifestations can develop in a small proportion of patients. A full evaluation for the underlying cause is required, because each type requires a different kind of treatment, which should be tailored on the basis of disease severity, underlying disease, and prior therapies. Relapses can be frequent and can result in significant morbidity and cumulative organ impairment. We explore the spectrum of this heterogeneous disease by discussing the disease characteristics of 5 different patients.

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Section: Case 4: Hcv-associated (Infectious) Mixed Cryoglobulinemiamentioning

confidence: 99%

How I treat cryoglobulinemia

Muchtar

Magen

Gertz

2017

Blood

136

146

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“…Recently it has been shown that HCV infection may lead to a substantial reduction in quality of life, with a key role played by depression, cognitive disorders and asthenia (60). The correct diagnosis of HCVrelated EHMs is clinically important to ensure early detection of the infection and prevent evolution towards LPD and NHL, starting the best treatment that in the majority of subjects should A c c e p t e d M a n u s c r i p t 18 be antiviral therapy with DAAs, despite no significant liver damage (61)(62)(63)(64). It should be emphasized that antiviral therapy for HCV was clearly shown to be effective against a wide spectrum of EHMs.…”

Section: Extra-hepatic Manifestationsmentioning

confidence: 99%

From current status to optimization of HCV treatment: Recommendations from an expert panel

Craxı̀

Perno

Viganò

et al. 2016

Digestive and Liver Disease

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Chronic hepatitis C virus (HCV) infection is a major public health problem at a global level, causing an enormous burden of hepatic and extra-hepatic morbidity and mortality. Treatment of chronic HCV (CHC) has been revolutionized in the last few years by the introduction of highly effective and well tolerated direct acting antiviral agents (DAAs) able to achieve >90% rates of sustained virological response (SVR) in many groups of patients, including those previously excluded from interferon-based regimens. For such reason interferon-free regimens are now the treatments of choice for all patients. Successful anti-HCV treatment can stop liver disease progression and can solve the HCV-related extra hepatic manifestations, eventually reducing both liver-related and overall mortality. Together with the rapidly accumulating data about the evolution of treatment landscape, different guidelines from national and international Liver Scientific Societies have been published until today. However, these recommendations may not be applied worldwide as, due to high treatment costs, most of them identify as priority groups only patients with advanced liver disease. Moreover some types of patients pose clinical management problems for which even the guidelines do not always provide useful answers. With the aim of treatment optimization by filling some of the gaps of the current guidelines and addressing the remaining unmet needs in practice, a group of Italian experts, experienced on treatment of HCV infection, met in Stresa in February 2016. The summary of all the considerations arising from this two-day meeting and the final statements are reported in this position paper.

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“…So far, a few studies have reported promising results on the efficacy and tolerability of DAA therapy in patients with HCV‐associated MC, either in association with IFN or using IFN‐free regimens, and in patients with HCV‐associated NHL …”

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confidence: 99%