Dual Antiviral Treatment:Treating HCV-Associated Cryoglobulinemic Vasculitis

Dual Antiviral Treatment May Have Edge in Treating HCV-Associated Cryoglobulinemic Vasculitis

NEW YORK (Reuters Health) - Dual antiviral therapy seems more effective than standard immunosuppression or rituximab only at treating cryoglobulinemic vasculitis associated with hepatitis C virus (HCV) infection, researchers from Russia report.

Cryoglobulinemic vasculitis may affect 5% of patients with HCV infection. Previous research has shown both rituximab and antiviral treatment to be effective in these patients, Dr. Sergey Moiseev and colleagues from First Moscow State Medical University note in Annals of the Rheumatic Diseases, online June 12.

The team looked at outcomes of 65 of their patients with HCV-associated mixed cryoglobulinemic vasculitis who were treated with conventional immunosuppressive drugs (n=30), monotherapy with interferon alpha (n=9), rituximab (n=8), or peginterferon alpha-ribavirin with or without rituximab (n=18).

Relapse-free survival was numerically longer with antiviral treatment than with rituximab or conventional treatment, the researchers found.

More than 70% (5/7) of patients treated with interferon alpha monotherapy experienced deterioration of vasculitis, compared with only one of 18 patients treated with dual antiviral therapy with or without rituximab.

Just over half of patients with genotype 1 (8/15) and all three patients with genotype 2 or 3 infection experienced sustained virological response with combination antiviral treatment. Seven of these 18 patients developed hematological complications.

The researchers acknowledge that lack of randomization and small sample size represent significant limitations of their study.

"Dual antiviral treatment is better tolerated and in our opinion can be offered to patients with higher probability of sustained virological response to peginterferon-alpha/ribavirin, for example, with favorable interleukin-28B polymorphism," the authors conclude.

"Recently, a large scale trial showed high efficacy and excellent safety of the single tablet regimen of ledipasvir-sofosbuvir for primary patients with HCV genotype 1 infection," they add. "The study of these and other interferon-free regimens are also warranted in patients with HCV-associated mixed cryoglobulinemic vasculitis."

Dr. Moiseev did not respond to a request for comments.

SOURCE
Ann Rheum Dis 2014.