Rituximab plus Peg-interferon-α/ribavirin compared with Peg-interferon-α/ribavirin in hepatitis C–related mixed cryoglobulinemia

Abstract

Treatment of hepatitis C (HCV)-

Treatment with rituximab in patients with mixed cryoglobulinemia syndrome: Results of multicenter cohort study and review of the literature

“…This multicenter, retrospective study including a large patients' series further supports and expands the results of previous reports showing the usefulness of rituximab in active MCs [9][10][11][12][24][25][26][27][28][29][30][31]. The positive effects of this treatment were particularly evident for the most frequent disease manifestations such cutaneous vasculitic lesions, i.e.…”

“…In this respect, previous studies clearly demonstrated that, when present, the increase of HCV viral load did not affect the liver texts as well as other clinico-serological parameters [11,12]. The lack of hepatic toxicity has been further evidenced by a recent clinical observation in patients with HCVrelated MCs and advanced cirrhosis treated by rituximab [29,49]; besides its efficacy on cryoglobulinemic vasculitis the treatment was followed by an improvement of liver function. It is possible to ascribe this unexpected hepatic amelioration to the depletion of CD20+ B-cells induced by rituximab through two different mechanisms; firstly, the drug may reduce also the hepatic B-cell infiltrates conditioning liver damage and, indirectly, it may improve the Kupffer cell function as consequence of serum cryoglo-bulin level reduction [28].…”

“…Review papers were excluded. A total of 39 manuscripts that reported on at least one case of cryoglobulinemic vasculitis treated with rituximab were included in the present analysis [9][10][11][12][24][25][26][27][28][29][30][31]. Three manuscripts were excluded because they included patients that had already been described in other publications [9,11,37].…”

“…The cumulative dosage of rituximab cycles and treatment modalities were quite uniform; generally the schedule included four consecutive intravenous in-fusions of 375 mg/m2/week of rituximab (69%). In 3 recent studies [26,29,30], the rituximab was associated to antiviral therapy (Peg-interferon-alpha + ribavirin), while in one with other immunosup-pressive or antiblastic drugs [34] (Table 3). After the first 6-month follow-up, a clear-cut clinical improvement of main cryoglobulinemic manifestations was observed in the majority of cases (Table 3).…”

“…The safety and efficacy of this drug have been reported in various vasculitides and other systemic autoimmune diseases [13][14][15][16][17][18][19][20][21][22][23]. The usefulness of monoclonal antibodies directed to CD20 antigen, a trans membrane protein expressed on pre-B lymphocytes and mature B lymphocytes, on both cutaneous and visceral organ involvement of MCs, including low grade B-cell lymphoma, has been reported by various Authors, generally referred to small patients' series [24][25][26][27][28][29][30][31]. These are often characterized by a heterogeneous composition of clinical manifestations that does not permit an accurate evaluation of the effect of rituximab on single organ involvement.…”