Sustained response to interferon‐α or to interferon‐α plus ribavirin in hepatitis C virus‐associated symptomatic mixed cryoglobulinaemia

Abstract

Interferon as monotherapy or combined with ribavirin is a safe and effective treatment in patients with HCV-associated MC. The presence of cryoglobulins does not affect the response to anti-viral treatment in patients with HCV infection. The eradication of HCV is associated with an improvement or disappearance of MC-associated clinical manifestations.

Efficacy and safety of rituximab in type II mixed cryoglobulinemia

“…[29][30][31] Of note, antiviral treatment against HCV proved effective in type II MC. 1,[3][4][5][6][7][8] Reduction of RF, cryoglobulins, and lymphoproliferation has been reported, in particular, in the subset of patients where HCV RNA became negative after treatment. [3][4][5][6][7][8] On the other hand, antiviral therapy may also fail, or may prove poorly tolerated or counterindicated, in many patients with type II MC.…”

“…1,[3][4][5][6][7][8] Reduction of RF, cryoglobulins, and lymphoproliferation has been reported, in particular, in the subset of patients where HCV RNA became negative after treatment. [3][4][5][6][7][8] On the other hand, antiviral therapy may also fail, or may prove poorly tolerated or counterindicated, in many patients with type II MC. [1][2][3][4][5][6][7][8][9][10][11][12] Furthermore, RF-positive B-cell clones may be stimulated by immune complexes with IgG bound to quite different antigens, 32 and clinical studies demonstrate the persistence of serum RF and cryoglobulins in most patients with type II MC despite the HCV RNA negativization.…”

“…1,2 The treatment of HCV-associated MC with severe organ involvement remains difficult at present and may target either the viral trigger HCV, when present, or the downstream pathogenic events by means of less specific approaches such as corticosteroids, immunosuppressors, or plasmapheresis. 1 There is clinical evidence that effective anti-HCV treatment with interferon (old studies) 1,[3][4][5][6] or interferon plus ribavirin (recent studies) [6][7][8] often gave positive results on MC, but results may differ for the different organ manifestations and, rarely, some manifestations are worsened or even directly induced by interferon. 9,10 Antiviral therapy also may prove ineffective, contraindicated, or not tolerated.…”

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

“…7 Combination of ribavirin (RBV) with IFN-␣ has remarkably improved the clinical response of both chronic hepatitis C 8 and HCV-positive MC patients in a few uncontrolled pilot trials: 19% to 54% of patients who did not respond to IFN-␣ alone achieved a sustained virologic response (SVR) and clinical remission from MC complications. 9 In another study, 10 although only 2 (22.2%) of 9 patients had an SVR, all patients showed a substantial improvement of clinical symptoms (including arthralgias, purpura, and proteinuria) and laboratory parameters. Favorable responses attaining an SVR and a complete clinical response in more than 70% of the patients have also been reported by Cacoub et al 11,12 In addition to its obvious antiviral efficacy, pegylated IFN-␣ (Peg-IFN-␣) is characterized by a longer half-life, a smaller volume of distribution, and a slower clearance compared with standard IFN-␣.…”

Expression of MicroRNA miR-122 Facilitates an Efficient Replication in Nonhepatic Cells upon Infection with Hepatitis C Virus

“…EHMs are frequently more serious than hepatic disease in some patients and sometimes occur even in patients with persistently normal liver functions (19). Mixed cryoglobulinemia is the most-well-characterized HCV-associated disease and is curable by viral clearance through antiviral therapies (6). Although replication of HCV RNA in peripheral blood mononuclear cells (PBMCs) and neuronal cells at a low level was suggested (64), the biological significance of the extrahepatic replication of HCV, particularly in the development of EHMs, is not well understood.…”