Virological and Clinical Response to Interferon-Free Regimens in Patients with HCV-Related Mixed Cryoglobulinemia: Preliminary Results of a Prospective Pilot Study

• Published in: Current drug targets Vol. 18; no. 7; p. 772
• Main Authors: Gragnani, Laura, Piluso, Alessia, Urraro, Teresa, Fabbrizzi, Alessio, Fognani, Elisa, Petraccia, Luisa, Genovesi, Alessandro, Giubilei, Lidia, Ranieri, Jessica, Stasi, Cristina, Monti, Monica, Zignego, Anna Linda
• Format: Journal Article
• Language: English
• Published: United Arab Emirates 01.01.2017
• Subjects: Aged; Anilides - administration & dosage; Anilides - pharmacology; Antiviral Agents - administration & dosage; Antiviral Agents - pharmacology; Carbamates - administration & dosage; Carbamates - pharmacology; Cryoglobulinemia - drug therapy; Cryoglobulinemia - virology; Female; Hepacivirus - drug effects; Hepacivirus - genetics; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - drug therapy; Humans; Macrocyclic Compounds - administration & dosage; Macrocyclic Compounds - pharmacology; Male; Middle Aged; Pilot Projects; Prospective Studies; Ritonavir - administration & dosage; Ritonavir - pharmacology; RNA, Viral - drug effects; Treatment Outcome; interferon-free (IFN-free); Antiviral treatment; safety; direct-acting antiviral (DAA); HCV; efficacy; mixed cryoglobulinemia
• ISSN: 1873-5592
• DOI: 10.2174/1389450117666160208145432

Mixed Cryoglobulinemia (MC) is the most frequent extrahepatic manifestation of Hepatitis C virus (HCV) infection. MC is an autoimmune /B-cell lymphoproliferative disorder characterized by circulating immune-complexes, named cryoglobulins. MC patients exhibit symptoms due to a systemic vasculitis of small/medium size vessels (mixed cryoglobulinemia syndrome, MCS) in a percentage going from 5 to 30%. The first-line therapeutic option in MCS patients is the etiologic treatment and, in the past fifteen years, antiviral therapy with Pegylated-Interferon (Peg-IFN) plus Ribavirin (RBV) represented the standard of care. Lately, the arrival of direct acting antivirals (DAAs) significantly modified the cure of HCV infection, consenting the use of IFN-free regimens. Here we report a review of the literature about the role of antiviral treatment, following its evolution, in treating HCVrelated MC. Furthermore, we report the results, after 8 weeks of treatment, of a preliminary pilot prospective study, counting 17 patients with HCV-related MC with or without MCS, treated with new generation DAAs in IFN-free regimens. After 8 weeks of DAA administration, all the subjects were HCV RNA negative. Moreover, in 6/17 (35%) patients cryoglobulins disappeared and, on the whole, in all patients a decrease of the cryocrit values was observed (p<0.05). Furthermore, three MCS-HCV patients (30%) resulted to be complete clinical responders and 5 subjects (50%) partial clinical responders. Therefore, IFN-free anti-HCV treatment appears to be safe and effective in MC patients from virological and clinical points of view, thus supporting the importance of HCV eradication in leading MC remission.