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

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The Liver Meeting 2015

Note:  A particular type of Cryoglobulinemia is a caused by the hepatitis C virus. Cryoglobulinemia is a blood disorder caused by abnormal proteins in the blood called cryoglobulins that precipitate or clump together when blood is chilled, and the proteins dissolve when the blood is warmed.  When these proteins develop they can be deposited in small and medium-sized blood vessels that can affect the skin, kidneys, nerves, and joints.  Those who have Cryoglobulinemia can have mild, moderate to severe disease.  Cryoglobulinemia (listed as MC in the abstract below) can also cause other diseases such as vasculitis (listed as MCS in the abstract) as listed in the abstract below. Check out our fact sheet on extrahepatic manifestations including Cryoglobulinemia by clicking here 

The abstract below is from The Liver Meeting 2016 that documents treating hepatitis C and Cryoglobulemina.  The authors found that treating HCV and Cryoglobulemina with direct acting antiviral medications is safe, effective and in some people with Cryoglobulemina the cryoglobulin proteins disappear from the blood.  The final results have not yet been released, but I will update our readers as soon as they are available.  Alan

Abstract No.: 1190

Abstract Title
 Virological and Clinical Response in Patients with HCV-Related Mixed Cryoglobulinemia Treated with Interferon-Free Regimens: Preliminary Results of a Prospective Pilot Study—L. Gragnani et al.  

Hepatitis C virus (HCV) infection is often associated with extrahepatic manifestations: the most frequent is represented by mixed cryoglobulinemia (MC). MC is an autoimmune/B-cell lymphoproliferative disorder, characterized by the presence of circulating immune complexes, called cryoglobulins.  In 5–30% of cases, MC patients showed symptoms due to a systemic vasculitis of small/medium size vessels (mixed cryoglobulinemia syndrome, MCS). The etiologic therapy was considered the first-line option in MCS patients. However, interferon (IFN)-based therapy is frequently not tolerated. Recently, the introduction of direct-acting antivirals (DAAs) substantially changed the treatment of HCV infection, allowing IFN-free regimens. No data at present exist about the use of IFN-free regimens in MC patients.
Our aim was to analyze the efficacy and safety of new generation DAAs in IFN-free regimens in MC patients.

Pilot prospective study, including 17 patients with HCV-associated MC with or without symptoms treated with new generation DAAs in IFN-free regimens. Patients were treated, for 12 or 24 weeks, with different all-oral antiviral regimen: ombitasvir, paritaprevir plus ritonavir and dasabuvir with and without ribavirin; sofosbuvir plus daclatasvir and sofosbuvir plus ribavirin.

Patients were divided in two different cohorts as follows:

      (a) 10 patients (3 [27.3%] males, mean age 64.73±6.6 years) in the MCS-HCV group,

      (b) 7 patients (4 [57.1%] males, mean age 55.57±10.52 years) in the MC-HCV group.

The main clinical baseline manifestation or symptoms of Cryoglobulinemia included purpura (80%), arthralgia (80%), asthenia (100%), peripheral neuropathy (90%), renal involvement (40%) and cutaneous ulcers (30%).

Regarding previous anti-HCV treatment, 7 (41%) patients were naïve, 6 (35%) were partial or non responders, 1 (6%) patient was virological relapser and 3 (18%) discontinued previous treatment for severe adverse events.

At week 8 of treatment, all patients were HCV RNA negative. Furthermore, a reduction of the cryocrit values was evident in all cases (p<0.05) with the disappearance of cryoglobulins in 6/17 patients (35%). Moreover, three MCS-HCV patients (30%) were complete clinical responders and 5 patients (50%) partial clinical responders.


IFN-free anti-HCV therapy seems to be safe and effective in patients with MC and MCS from both virological and clinical points of view, thus confirming the key role played by HCV eradication in inducing MC remission.

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