Efficacy and safety of rituximab in type II mixed cryoglobulinemia

Abstract

The best treatment of type II mixed cryoglobulinemia (MC) has still to be defined. Antiviral treatment for the frequent underlying infectious trigger hepatitis C virus (HCV) may be ineffective, contraindicated, or not tolerated in a fraction of cases, whereas current immunosuppressive treatments may lead to relevant complications. Selective B-cell blockade with rituximab was used in this study, based on favorable results in preliminary experience.

Rituximab-based novel strategies for the treatment of immune-mediated glomerular diseases

“…Both sensory and motor neuropathy improved 1-5 months after RTX [38], [40], [41] and [51]. Interestingly, RTX therapy exerted a steroid-sparing effect on MC [37], and some patients, including cases with active nephritis, were treated ab initio without steroids [39]. RTX also restored some MC-related immune abnormalities [52].…”

“…Glomerulonephritis responded within the first three months of treatment. Skin ulcers usually improved within three months after the beginning of RTX therapy, but complete healing required a longer time [37], [38] and [40]. Both sensory and motor neuropathy improved 1-5 months after RTX [38], [40], [41] and [51].…”

“…Encouraging results have been obtained in open-label studies and single case reports. RTX improves or cures various clinical manifestations of MC, including fatigue, purpura and skin ulcers, arthralgias and arthritis, glomerulonephritis (in about 90% of cases), peripheral neuropathy (in about 75% of cases), and hyperviscosity syndrome [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50] and [51]. RTX was also reported to be effective in some life-threatening cases of gastrointestinal vasculitis [43].…”

Viral infection and reactivation in autoimmune disease

“…Case reports and small clinical trials with this agent in patients with HCV-associated cryoglobulinemic vasculitis have indicated favorable short-term clinical responses without significant hepatotoxicity, although elevation of HCV RNA levels during treatment was noted in some patients (52)(53)(54).…”

Characterization of B cell lymphoma in patients with Sjögren's syndrome and hepatitis C virus infection

“…This heterogeneity in treating B cell lymphoma was also observed in our retrospective multicenter series of patients with SS-HCV, although etiopathogenically, 2 therapeutic options should be highlighted as future options. The first is the use of monoclonal agents against B cells (rituximab or epratuzumab), which have been successfully used to treat not only B cell lymphomas (44) but also cryoglobulinemic vasculitis (45), with the aim of controlling the marked B cell hyperreactivity observed in patients with SS-HCV. The second is the use of antiviral agents (interferon and ribavirin), which aim to eradicate the virus as the main causative agent of this B cell hyperactivity, and which was successfully used in some of our patients.…”