TY - JOUR
T1 - Long-term effect of HCV eradication in patients with mixed cryoglobulinemia
T2 - A prospective, controlled, open-label, cohort study
AU - MaSVE Study Group
AU - Gragnani, Laura
AU - Fognani, Elisa
AU - Piluso, Alessia
AU - Boldrini, Barbara
AU - Urraro, Teresa
AU - Fabbrizzi, Alessio
AU - Stasi, Cristina
AU - Ranieri, Jessica
AU - Monti, Monica
AU - Arena, Umberto
AU - Iannacone, Claudio
AU - Laffi, Giacomo
AU - Zignego, Anna Linda
AU - Barbara, Boldrini
AU - Caini, Patrizio
AU - Villa, Giorgio La
AU - Moscarella, Stefania
AU - Romanelli, Roberto Giulio
AU - Guerra, Cristina Tosti
AU - Abbate, Rosanna
AU - Boddi, Maria
AU - Bosi, Alberto
AU - Rigacci, Luigi
AU - Pimpinelli, Nicola
AU - Moneglia, Martina
AU - Nacmias, Benedetta
AU - Pallanti, Stefano
AU - Sorbi, Sandro
N1 - Publisher Copyright:
© 2014 by the American Association for the Study of Liver Diseases.
PY - 2015/4/1
Y1 - 2015/4/1
N2 - Limited data are available about the efficacy of antiviral treatment in hepatitis C virus (HCV)-associated mixed cryoglobulinemia (MC), especially concerning the long-term effects of HCV eradication. The aim of this study was to evaluate the influence of MC on the virological response and the long-term effects of viral eradication on MC. We prospectively enrolled 424 HCV+ patients belonging to the following groups: MC syndrome (MCS)-HCV (121 patients with symptomatic MC), MC-HCV (132 patients with asymptomatic MC), and HCV (158 patients without MC). Pegylated interferon plus ribavirin treatment was administered according to standard protocols. Posttreatment follow-up ranged from 35 to 124 months (mean 92.5 months). A significant difference was observed in the rate of sustained virological response between the HCV group and both the MC-HCV (P=0.009) and MC-HCV+MCS-HCV (P=0.014) groups. Multivariate logistic regression analysis identified cryoglobulinemia as an independent prognostic factor of nonresponse. The clinical-immunological response in MCS-HCV correlated with the virological one. All patients with sustained virological response also experienced a sustained clinical response, either complete or partial. In the majority of sustained virological response patients all MCS symptoms persistently disappeared (36 patients, 57%); in only two (3%) did definite MCS persist. All virological nonresponders were also clinical nonresponders, in spite of a transient improvement in some cases. No evolution to lymphoma was observed. For the first time we have evaluated both the effects of interferon-based therapy on HCV patients with and without MC and with and without symptoms, as well as the long-term effects of viral eradication on MC. Conclusion: MC is a negative prognostic factor of virological response. Clearance of HCV led to persistent resolution or improvement of MCS, strongly suggesting the need for a next generation of highly effective antiviral drugs.
AB - Limited data are available about the efficacy of antiviral treatment in hepatitis C virus (HCV)-associated mixed cryoglobulinemia (MC), especially concerning the long-term effects of HCV eradication. The aim of this study was to evaluate the influence of MC on the virological response and the long-term effects of viral eradication on MC. We prospectively enrolled 424 HCV+ patients belonging to the following groups: MC syndrome (MCS)-HCV (121 patients with symptomatic MC), MC-HCV (132 patients with asymptomatic MC), and HCV (158 patients without MC). Pegylated interferon plus ribavirin treatment was administered according to standard protocols. Posttreatment follow-up ranged from 35 to 124 months (mean 92.5 months). A significant difference was observed in the rate of sustained virological response between the HCV group and both the MC-HCV (P=0.009) and MC-HCV+MCS-HCV (P=0.014) groups. Multivariate logistic regression analysis identified cryoglobulinemia as an independent prognostic factor of nonresponse. The clinical-immunological response in MCS-HCV correlated with the virological one. All patients with sustained virological response also experienced a sustained clinical response, either complete or partial. In the majority of sustained virological response patients all MCS symptoms persistently disappeared (36 patients, 57%); in only two (3%) did definite MCS persist. All virological nonresponders were also clinical nonresponders, in spite of a transient improvement in some cases. No evolution to lymphoma was observed. For the first time we have evaluated both the effects of interferon-based therapy on HCV patients with and without MC and with and without symptoms, as well as the long-term effects of viral eradication on MC. Conclusion: MC is a negative prognostic factor of virological response. Clearance of HCV led to persistent resolution or improvement of MCS, strongly suggesting the need for a next generation of highly effective antiviral drugs.
UR - http://www.scopus.com/inward/record.url?scp=84925354497&partnerID=8YFLogxK
U2 - 10.1002/hep.27623
DO - 10.1002/hep.27623
M3 - Article
C2 - 25431357
AN - SCOPUS:84925354497
SN - 0270-9139
VL - 61
SP - 1145
EP - 1153
JO - Hepatology
JF - Hepatology
IS - 4
ER -