Efficacy and tolerability of rituximab with or without PEGylated interferon alfa‐2b plus ribavirin in severe hepatitis C virus–related vasculitis: A long‐term followup study of thirty‐two patients

Abstract

Objective. To report on the long-term followup of a cohort of patients with hepatitis C virus (HCV)-related vasculitis treated with rituximab with or without PEGylated interferon alfa-2b (PEG-IFN alfa-2b) plus ribavirin.Methods. The study group comprised 32 HCV RNA-positive patients with HCV-related vasculitis: 20 patients were treated with rituximab and PEG-IFN alfa-2b (9 of whom had not previously received antiviral treatment and 11 of whom had experienced disease resistance to or relapse with antiviral treatment), and 12 antiviral-intolerant patients were treated with rituximab alone.Results. Treatment with rituximab and PEG-IFN alfa-2b plus ribavirin induced a complete clinical response and a partial clinical response in 80% and 15% of patients, respectively, a complete immunologic response and a partial immunologic response in 67% and 33% of patients, respectively, and a sustained virologic response in 55% of patients. Treatment with rituximab alone induced a complete clinical response and a partial clinical response in 58% and 9% of patients, respectively, and a complete immunologic response and a partial immunologic response in 46% and 36% of patients, respectively. B cell depletion was achieved in 96% of patients, and B cell recovery began after a median delay of 12 months. After a mean ؎ SD followup period of 23 ؎ 12 months, 22% of patients experienced a clinical relapse, and 34% of patients experienced an immunologic relapse. All relapses were associated with the absence of virologic control, and 78% of relapses were associated with B cell recovery. Six patients were re-treated with rituximab. All 6 of these patients had a complete clinical response, 50% had a complete immunologic response, and 50% had a partial immunologic response. Rituximab was well tolerated overall.Conclusion. Rituximab is an effective treatment of severe and/or refractory HCV-related vasculitis. Relapses were consistently associated with the absence of virologic control. The clinical and immunologic efficacy of rituximab after repeated infusion appeared to be the same as that observed after induction therapy.Mixed cryoglobulinemia (MC) vasculitis is a systemic vasculitis that affects mainly the small and, less

Patterns of Noncryoglobulinemic Glomerulonephritis with Monoclonal Ig Deposits

“…On the other hand, rituximab has a very favorable benefitto-tolerance ratio in this subgroup of patients. This treatment has been proposed in several kidney diseases such as mixed hepatitis-C-related cryoglobulinemic MPGN (18) or idiopathic MN (19). In the series reported by Nasr (8), two of four patients with MPGN and monoclonal IgG deposits who received this B cell-depleting drug experienced PR.…”

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

“…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].…”

“…Except for transplanted patients, no life-threatening infections have been reported in typical HCV-related MC after RTX administration. While antiviral drugs administered with RTX may possibly be synergic [44], [56], [57], [58] and [59], they multiply the adverse effects thereby making treatment poorly tolerated. Until recently, it was believed that staggered administration after a critical phase of vasculitis was mandatory in order to avoid the risk of exacerbating HCV infection, but in most cases it is probably unnecessary [60].…”

Pegylated interferon-α, ribavirin, and rituximab combined therapy of hepatitis C virus–related mixed cryoglobulinemia: a long-term study

“…Thus, to avoid this adverse effect and stabilize the deletion of expanded B-cell clones, it seemed reasonable to combine Peg-IFN-␣ and RBV with RTX (termed PIRR). 16,32 We here describe a long-term, single-center experience with this combination in selected adult patients with HCV-related MC and no prior exposure to immunosuppressive or antiviral drugs.…”