Abstract
Mixed cryoglobulinemia (MC) is the most common extrahepatic manifestation of chronic hepatitis C (CHC), with the presence of symptoms in 10–15% of cases. There have been encouraging data regarding immunological and clinical responses in patients treated with the novel combinations of direct-acting antivirals (DAAs), but the role of ribavirin (RBV) in the treatment of MC has not yet been demonstrated. We prospectively enrolled 132 patients affected by MC and CHC, and virological, immunological and clinical responses were evaluated at 12 weeks after completion of treatment. All subjects were treated with interferon (IFN)-free regimens according to clinical guidelines, with or without RBV. All patients achieved a virological response. A complete immunological response (CR) was observed in 71 subjects (53.8%), a partial response in 44 (33.3%), and no response in 17 (12.8%). Ten patients showed a complete resolution of symptoms (7.6%), and 31 showed a significant improvement (23.5%). CR was significantly higher in patients taking RBV (71.1 vs. 44.8%, p < 0.001) and in treatment-naïve patients (62.5 vs. 43.3%, p < 0.001). In logistic regression analysis, duration of HCV infection of less than 20 years (OR 2.448; 95% IC 1.335–6.202; p = 0.019), treatment-naïve status (OR 2.885; 95% IC 1.404–9.660; p = 0.025) and the use of RBV (OR 6.961; 95% IC 3.912–26.885; p < 0.001) were predictors of CR. In MC patients, IFN-free regimens are effective and well tolerated, and RBV seems to significantly increase the immunological response and promote a decline in cryocrit.
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Abbreviations
- CHC:
-
Chronic hepatitis C
- HCV:
-
Hepatitis C virus
- DAAs:
-
Direct-acting antiviral agents
- DCV:
-
Daclatasvir
- SOF:
-
Sofosbuvir
- 3D:
-
Ombitasvir, paritaprevir/ritonavir, dasabuvir
- RBV:
-
Ribavirin
- SVR:
-
Sustained virological response
- IQR:
-
Inter-quartile range
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This study was approved by the ethics committee of “A.O.U. S. Luigi Gonzaga, Orbassano, Turin”, No. 186/14, in 26/5/2015.
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Informed consent was obtained from all individual participants included in the study.
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705_2017_3684_MOESM1_ESM.tif
Supplementary Figure 1: In this figure, the main concept of this paper is summarized: DAAs have an antiviral effect on HCV replication, while RBV enhances the innate immune response. The combination of these different mechanisms leads to immunological response and resolution of MC (TIFF 39 kb)
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Boglione, L., Cusato, J., Pinna, S.M. et al. Role of ribavirin in the treatment of hepatitis C virus-associated mixed cryoglobulinemia with interferon-free regimens. Arch Virol 163, 961–967 (2018). https://doi.org/10.1007/s00705-017-3684-7
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DOI: https://doi.org/10.1007/s00705-017-3684-7