Treatment of Hepatitis C Associated Mixed Cryoglobulinemia with Direct Acting Antiviral Therapy

Emery, Joel; Kuczynski, Magdalena; La, Danie; Kowgier, Matthew; Feld, Jordan J.

doi:10.1016/s0168-8278(16)01520-8

Cited by 6 publications

(7 citation statements)

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“…Very recently, in a nationwide Italian study, Kondili et al reported the disappearance or improvement of more than 50% of CryoVas symptoms in 31/37 (84%) patients after DAA, with no specific details on kidney parameters [78]. A Canadian group described eleven patients with symptomatic HCV-CryoVas who received IFN-free DAA combinations (mean age of 56 years old, 61% females, 57% cirrhotics) [79]. A full or partial clinical response of CryoVas symptoms was obtained in 91% of patients and a complete or partial immunological response in 81%.…”

Section: The Particular Case Of Hcv Cryoglobulinemia Vasculitis With mentioning

confidence: 99%

Hepatitis C virus infection and chronic kidney disease: Time for reappraisal

Cacoub

Desbois

Isnard-Bagnis

et al. 2016

Journal of Hepatology

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Hepatitis C virus (HCV) infection is associated with tremendous morbidity and mortality due to liver complications. HCV infection is also associated with many extrahepatic manifestations including cardiovascular diseases, glucose metabolism impairment, cryoglobulinemia vasculitis, B cell non-Hodgkin lymphoma and chronic kidney disease (CKD). Many studies have shown a strong association between HCV and CKD, by reporting (i) an increased prevalence of HCV infection in patients on haemodialysis, (ii) an increased incidence of CKD and proteinuria in HCV-infected patients, and (iii) the development of membranoproliferative glomerulonephritis secondary to HCV-induced cryoglobulinemia vasculitis. HCV seropositivity is found to be associated with an increased relative risk for all-cause and cardiovascular mortality in the dialysis population. HCV seropositivity is linked to lower patient and graft survival after kidney transplantation. Such poor HCV-associated prognosis should have encouraged clinicians to treat HCV in CKD patients. However, due to frequent side effects and the poor efficacy of interferon-based treatments, very few HCV dialysis patients have received HCV medications until now. The emergence of new direct acting, interferon-free antiviral treatment, leading to HCV cure in most cases with a satisfactory safety profile, will shortly modify the management of HCV infection in CKD patients. In patients with a glomerular filtration rate (GFR) >30ml/min, the choice of DAA is not restricted. In those with a GFR <30 and >15ml/min, only paritaprevir/ritonavir/ombitasvir/dasabuvir or a grazoprevir plus elbasvir regimen are approved. In patients with end stage renal disease (GFR <15ml/min or dialysis), current data only allows for the use of a grazoprevir plus elbasvir combination. No doubt these data will be modified in the future with the advent of new studies including larger cohorts of HCV patients with renal impairment.

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Section: The Particular Case Of Hcv Cryoglobulinemia Vasculitis With mentioning

confidence: 99%

Hepatitis C virus infection and chronic kidney disease: Time for reappraisal

Cacoub

Desbois

Isnard-Bagnis

et al. 2016

Journal of Hepatology

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“…This slow response was speculated as a possible reason why Sollima et al 42 reported poorer clinical outcomes in a small prospective study of seven patients with MCS, with only two of seven clinical responders at SVR12. Additionally, the Gragnani et al [39][40][41] study and others have suggested that some manifestations of MCS, including skin manifestations (ulcers, purpura) and kidney disease, may be more likely or faster to improve, while others including fatigue, sicca syndrome and peripheral neuropathy may be more refractory.…”

Section: Association With Hcvmentioning

confidence: 99%

“…Immunologically, there appear to be much lower rates of cryoglobulin clearance in HCV‐MC/MCS patients, with DAA studies reporting rates between 27% and 57% These rates are substantially lower than the SVR rates and not found to correlate with clinical response . In the case report literature, three patients had clearance of cryoglobulins, while two had persistence.…”

Section: Mixed Cryoglobulinaemiamentioning

confidence: 99%

“…Although studies of older regimens demonstrated that SVR in patients with MC was achieved at lower rates than in the general HCV population, 28,34,38 recent studies with DAA regimens have achieved SVR rates between 67% and 100%. 31,[39][40][41][42][43] While larger studies are needed, achieving SVR rates of up to 100% strongly suggests that these new drugs are efficacious even in this previously difficult-to-treat population.…”

Section: Association With Hcvmentioning

confidence: 99%

“…Sise et al 39 retrospectively analysed 12 patients with MCS who received sofosbuvir/ribavirin (four of 12 patients) or sofosbuvir/simeprevir (eight of 12 patients); of the five patients with baseline purpura, only one patient's purpura persisted after treatment. Emery et al 40 retrospectively analysed 48 patients with MC and 17 patients with MCS, 80% of whom received interferon-free regimens, and found that of the patients with MCS who achieved SVR, there was complete clinical response in 33% and partial response in 40%. Several case reports of HCV-MCS patients treated with DAA regimens report that all achieved SVR12 and had improvement or resolution of baseline symptoms.…”

Section: Association With Hcvmentioning

confidence: 99%

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Hepatitis C virus and its cutaneous manifestations: treatment in the direct‐acting antiviral era

Wiznia

Laird

Franks

2017

Acad Dermatol Venereol

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New all-oral direct-acting antivirals (DAA) have changed the hepatitis C virus (HCV) treatment landscape. Given that dermatologists frequently encounter HCV-infected patients, knowledge of the current treatment options and their utility in treating HCV-associated dermatologic disorders is important. In addition to highlighting the new treatment options, we review four classically HCV-associated dermatologic disorders - mixed cryoglobulinaemia (MC), lichen planus (LP), porphyria cutanea tarda (PCT) and necrolytic acral erythema (NAE) - and examine the role for all-oral direct-acting antiviral (DAA) regimens in their treatment. A literature search of English-language publications was conducted of the PubMed and EMBASE databases using search terms including 'hepatitis C', 'direct acting antivirals', 'cutaneous', 'mixed cryoglobulinemia', 'necrolytic acral erythema', 'lichen planus', 'porphyria cutanea tarda', 'rash', as well as specific drug names, related terms and abbreviations. Currently, limited data exist on the use of DAAs in HCV-infected patients with cutaneous side-effects, although treatment of the underlying HCV is now recommended for nearly all patients, with the new drugs offering much-improved dosage schedules and side-effect profiles. The most data exist for MC, in which several studies suggest that DAAs and achievement of sustained virologic response (SVR) improve cutaneous symptoms. Studies of both older and newer regimens are limited by their small size, retrospective nature, lack of appropriate controls and wide variability in study protocols. Given the strong association, screening for HCV should be considered in patients with MC, LP, PCT and NAE.

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Extrahepatic Manifestations of Hepatitis C Virus Infection

Desbois

Cacoub

2021

Hepatitis C: Care and Treatment

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Treatment of Hepatitis C Associated Mixed Cryoglobulinemia with Direct Acting Antiviral Therapy

Cited by 6 publications

References 0 publications

Hepatitis C virus infection and chronic kidney disease: Time for reappraisal

Hepatitis C virus infection and chronic kidney disease: Time for reappraisal

Hepatitis C virus and its cutaneous manifestations: treatment in the direct‐acting antiviral era

Extrahepatic Manifestations of Hepatitis C Virus Infection

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