Mixed cryoglobulinaemia is strongly related to hepatitis C virus infection. Treatment with peg-interferon and ribavirin has been indicated as first-line therapy for mild/moderate hepatitis C virus-related mixed cryoglobulinaemia. AIM: To evaluate the safety and efficacy of triple boceprevir-based antiviral therapy in patients with or without mixed cryoglobulinaemia previously treated with peg-interferon and ribavirin, and with advanced liver disease. METHODS: Thirty-five hepatitis C virus-positive patients (17 with asymptomatic mixed cryoglobulinaemia, 5 with symptomatic mixed cryoglobulinaemia, and 11 without mixed cryoglobulinaemia) were treated with triple boceprevir-based antiviral therapy. RESULTS: In 19/22 cryoglobulinaemic subjects (86%), the addition of boceprevir induced cryocrit disappearance. Cryocrit behaviour was related to virological response, with improvement of symptoms upon undetectable viraemia and reappearance after virological breakthrough. The rate of sustained virological response was lower in cryoglobulinaemic patients than in patients without mixed cryoglobulinaemia (23.8% vs 70% respectively, p=0.01). CONCLUSION: Boceprevir-based therapy was safe and effective in cryoglobulinaemic patients. The correlation between direct inhibition of hepatitis C virus replication and clinical improvement in mixed cryoglobulinaemic patients is definitive proof of the key pathogenetic role played by viral replication. Further studies are needed to confirm and clarify the reduced virological response in patients with mixed cryoglobulinaemia.

Triple antiviral therapy in hepatitis C virus infection with or without mixed cryoglobulinaemia: A prospective, controlled pilot study / Laura Gragnani; Alessio Fabbrizzi; Elisa Triboli; Teresa Urraro; Barbara Boldrini; Elisa Fognani; Alessia Piluso; Patrizio Caini; Jessica Ranieri; Monica Monti; Giacomo Laffi; Anna Linda Zignego. - In: DIGESTIVE AND LIVER DISEASE. - ISSN 1590-8658. - STAMPA. - 46:(2014), pp. 833-837. [10.1016/j.dld.2014.05.017]

Triple antiviral therapy in hepatitis C virus infection with or without mixed cryoglobulinaemia: A prospective, controlled pilot study.

GRAGNANI, LAURA;TRIBOLI, ELISA;URRARO, TERESA;FOGNANI, ELISA;PILUSO, ALESSIA;CAINI, PATRIZIO;RANIERI, JESSICA;MONTI, MONICA;LAFFI, GIACOMO;ZIGNEGO, ANNA LINDA
2014

Abstract

Mixed cryoglobulinaemia is strongly related to hepatitis C virus infection. Treatment with peg-interferon and ribavirin has been indicated as first-line therapy for mild/moderate hepatitis C virus-related mixed cryoglobulinaemia. AIM: To evaluate the safety and efficacy of triple boceprevir-based antiviral therapy in patients with or without mixed cryoglobulinaemia previously treated with peg-interferon and ribavirin, and with advanced liver disease. METHODS: Thirty-five hepatitis C virus-positive patients (17 with asymptomatic mixed cryoglobulinaemia, 5 with symptomatic mixed cryoglobulinaemia, and 11 without mixed cryoglobulinaemia) were treated with triple boceprevir-based antiviral therapy. RESULTS: In 19/22 cryoglobulinaemic subjects (86%), the addition of boceprevir induced cryocrit disappearance. Cryocrit behaviour was related to virological response, with improvement of symptoms upon undetectable viraemia and reappearance after virological breakthrough. The rate of sustained virological response was lower in cryoglobulinaemic patients than in patients without mixed cryoglobulinaemia (23.8% vs 70% respectively, p=0.01). CONCLUSION: Boceprevir-based therapy was safe and effective in cryoglobulinaemic patients. The correlation between direct inhibition of hepatitis C virus replication and clinical improvement in mixed cryoglobulinaemic patients is definitive proof of the key pathogenetic role played by viral replication. Further studies are needed to confirm and clarify the reduced virological response in patients with mixed cryoglobulinaemia.
2014
46
833
837
Laura Gragnani; Alessio Fabbrizzi; Elisa Triboli; Teresa Urraro; Barbara Boldrini; Elisa Fognani; Alessia Piluso; Patrizio Caini; Jessica Ranieri; Monica Monti; Giacomo Laffi; Anna Linda Zignego
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/956337
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