Safety and efficacy of rituximab in patients with hepatitis C virus–related mixed cryoglobulinemia and severe liver disease

The effectiveness of rituximab in hepatitis C virus (HCV)–related mixed cryoglobulinemia (MC) has been shown. However, the risk of an increase in viral replication limits its use in cirrhosis, a condition frequently observed in patients with MC. In this prospective study, 19 HCV-positive patients wi...

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Veröffentlicht in:Blood 2010-07, Vol.116 (3), p.335-342
Hauptverfasser: Petrarca, Antonio, Rigacci, Luigi, Caini, Patrizio, Colagrande, Stefano, Romagnoli, Paolo, Vizzutti, Francesco, Arena, Umberto, Giannini, Carlo, Monti, Monica, Montalto, Paolo, Matucci-Cerinic, Marco, Bosi, Alberto, Laffi, Giacomo, Zignego, Anna Linda
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Sprache:eng
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Zusammenfassung:The effectiveness of rituximab in hepatitis C virus (HCV)–related mixed cryoglobulinemia (MC) has been shown. However, the risk of an increase in viral replication limits its use in cirrhosis, a condition frequently observed in patients with MC. In this prospective study, 19 HCV-positive patients with MC and advanced liver disease, who were excluded from antiviral therapy, were treated with rituximab and followed for 6 months. MC symptoms included purpura, arthralgias, weakness, sensory-motor polyneuropathy, nephropathy, and leg ulcers. Liver cirrhosis was observed in 15 of 19 patients, with ascitic decompensation in 6 cases. A consistent improvement in MC syndrome was evident at the end-of-treatment (EOT) and end-of-follow-up (EOF-U). Variable modifications in both mean viral titers and alanine aminotransferase values were observed at admission, EOT, third month of follow-up, and EOF-U (2.62 × 106, 4.28 × 106, 4.82 × 106, and 2.02 × 106 IU/mL and 63.6, 49.1, 56.6, and 51.4 IU/L, respectively). Improvement in liver protidosynthetic activity and ascites degree was observed at EOT and EOF-U, especially in more advanced cases. This study shows the effectiveness and safety of rituximab in MC syndrome with advanced liver disease. Moreover, the depletion of CD20+ B cells was also followed by cirrhosis syndrome improvement despite the possibility of transient increases of viremia titers.
ISSN:0006-4971
1528-0020
DOI:10.1182/blood-2009-11-253948