Title:Virological and Clinical Response to Interferon-Free Regimens in Patients with HCV-Related Mixed Cryoglobulinemia: Preliminary Results of a Prospective Pilot Study
Volume: 18
Issue: 7
Author(s): Laura Gragnani, Alessia Piluso, Teresa Urraro, Alessio Fabbrizzi, Elisa Fognani, Luisa Petraccia, Alessandro Genovesi, Lidia Giubilei, Jessica Ranieri, Cristina Stasi, Monica Monti and Anna Linda Zignego*
Affiliation:
- Center for Systemic Manifestations of Hepatitis Viruses (MASVE), Department of Experimental and Clinical Medicine, University of Florence, largo Brambilla, 3, 50134- Florence,Italy
Keywords:
Antiviral treatment, direct-acting antiviral (DAA), efficacy, HCV, interferon-free (IFN-free), mixed cryoglobulinemia,
safety.
Abstract: 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.
