Prospective study of guideline‐tailored therapy with direct‐acting antivirals for hepatitis C virus‐associated mixed cryoglobulinemia

Gragnani, Laura; Visentini, Marcella; Fognani, Elisa; Urraro, Teresa; Santis, Adriano De; Petraccia, Luisa; Perez, Marie; Ceccotti, Giorgia; Colantuono, Stefania; Mitrevski, Milica; Stasi, Cristina; Padre, Martina Del; Monti, Monica; Gianni, Elena; Pulsoni, Alessandro; Fiorilli, Massimo; Casato, Milvia; Zignego, Anna Linda

doi:10.1002/hep.28753

Cited by 183 publications

(199 citation statements)

References 50 publications

Supporting

Mentioning

177

Contrasting

Unclassified

Order By: Relevance

“…Sustained virological response is the main goal in these patients since clinical remission of vasculitis is closely associated with viral clearance 8 . Few studies have reported promising results on the effectiveness and tolerance of direct acting antiviral drugs (DAA), either in association with interferon (IFN) or using IFN-free regimens [8][9][10][11] . The aim of the present study was to evaluate effectiveness and tolerance of an all oral IFN-and ribavirin-free regimen with sofosbuvir plus daclatasvir in patients with cryoglobulinemia vasculitis.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and Safety of Sofosbuvir Plus Daclatasvir for Treatment of HCV-Associated Cryoglobulinemia Vasculitis

et al. 2017

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

“…Median time to achieve a clinical response was twelve weeks. forty four patients treated by sofosbuvir based IFN-free regimen which included ribavirin in twenty eight patients 9 . All patients were virological responders and 93% improved M A N U S C R I P T Clearance of cryoglobulin is an important goal of the treatment of HCV-CryoVas.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Sofosbuvir Plus Daclatasvir for Treatment of HCV-Associated Cryoglobulinemia Vasculitis

et al. 2017

View full text Add to dashboard Cite

“…For at least some patients with severe cryoglobulinemia achievement of SVR may be insuffi cient to complete mitigate its manifestations, and additional support with rituximab and/or plasmapheresis may still be required. However, this report and others indicate that inferior SVR rates in HCV patients with cryoglobulinemia have been overcome with DAA therapy ( 8,9 ), and that clinical improvement, although not inevitable, typically follows. Th e enhanced effi cacy of DAA has simplifi ed management of this important manifestation of HCV infection.…”

mentioning

confidence: 66%

Editorial: Benefit of Direct-Acting Antiviral Therapy For Cryoglobulinemia due to Hepatitis C Infection

Martin

Fabrizi

2017

American Journal of Gastroenterology

View full text Add to dashboard Cite

Extrahepatic consequences of hepatitis C infection are increasingly recognized as a source of additional morbidity distinct from the consequences of liver disease. Among the best characterized of these is mixed cryoglobulinemia, which can lead to a variety of disorders, including vasculitis and glomerulonephritis. In general, the results of antiviral therapy in the interferon era had been disappointing, but now with new all-oral regimens response rates are substantially better. However, even with successful clearance of the virus symptomatic response can lag. Am J Gastroenterol 2017; 112:1309-1310 doi: 10.1038/ajg.2017 Infection with the hepatitis C virus (HCV) has been implicated in a variety of adverse extrahepatic consequences, with its role convincingly established in the pathogenesis of mixed cryoglobulinemia syndrome (MCS), in which underlying HCV infection is almost always present ( 1 ). Th is phenomenon refl ects the presence of circulating immunoglobulins, which precipitate when serum is cooled below body temperature and dissolve when heated to 37 °C. Th ree types of cryoglobulins are recognized. Type I, a single monoclonal immunoglobulin, occurs with B-cell lymphoproliferative disorders. In contrast, HCV-associated MCS is due to type II cryoglobulins, which include a polyclonal immunoglobulin, IgG, and a monoclonal immunoglobulin, IgM, with rheumatoid factor activity. Type III is a polyclonal IgM, which again occurs with rheumatoid activity. Despite detection of circulating cryoglobulins in a large number of HCV-infected patients, only a minority experience major clinical manifestations ( 2 ), which include vasculitis, palpable purpura, and glomerulo nephritis. Other symptoms of mixed cryoglobulinemia include fatigue, arthralgia, and neuropathy. Severe vasculitis and advanced-stage fi brosis are implicated in worse prognosis in patients with HCV-related MCS ( 3 ), whereas successful anti viral therapy for HCV improves prognosis. Other interventions for HCV-related MCS have included plasmapheresis and rituximab ( 4 ), which can provide temporary control of symptoms, but with a high rate of relapse.In the current issue, Emery and colleagues report their experience with use of direct-acting antivirals (DAAs) in HCVinfected patients with cryoglobulinemia ( 5 ). Th e patients were treated between 2011 and 2015 with specifi c antiviral regimens chosen by the treating physician, and as a result some patients received interferon-based therapy combined with a DAA rather than an all-oral regimen. Of the 83 treated patients 18 had symptomatic cryoglobulinemia, and of these two-thirds had cirrhosis. Sustained virological response rates were 88.9% and 90.8% in symptomatic and asymptomatic patients, respectively, with a trend towards higher SVR rates with interferon-free regimens. In contrast to earlier reports with purely interferon-based therapy, the presence of cryoglobulinemia did not reduce SVR ( 6 ). Despite the impressive SVR achieved in the symptomatic patients, however, clinical improvement was no...

show abstract

“…The available data suggest that IFN-free regimens are safe, generally well-tolerated, and effective in MC patients [140][141][142][143]. In the IFN era, rituximab was administered mostly to patients who had failed or were not eligible for antiviral therapy, even if a rituximab plus antiviral combination was suggested for patients with severe manifestations (generally using rituximab before antiviral therapy) [132,[144][145][146].…”

Section: Extrahepatic Manifestations Of Hcv: Mixed Cryoglobulinemiamentioning

confidence: 99%

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

et al. 2017

View full text Add to dashboard Cite

show abstract

Prospective study of guideline‐tailored therapy with direct‐acting antivirals for hepatitis C virus‐associated mixed cryoglobulinemia

Cited by 183 publications

References 50 publications

Efficacy and Safety of Sofosbuvir Plus Daclatasvir for Treatment of HCV-Associated Cryoglobulinemia Vasculitis

Efficacy and Safety of Sofosbuvir Plus Daclatasvir for Treatment of HCV-Associated Cryoglobulinemia Vasculitis

Editorial: Benefit of Direct-Acting Antiviral Therapy For Cryoglobulinemia due to Hepatitis C Infection

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

Contact Info

Product

Resources

About