PegIFNα/ribavirin/protease inhibitor combination in severe hepatitis C virus-associated mixed cryoglobulinemia vasculitis.

Abstract

BACKGROUND & AIMS The aim of this study was to analyse the safety and efficacy of the PegIFNα/ribavirin/protease inhibitor combination in severe and/or refractory hepatitis C virus (HCV)-mixed cryoglobulinemia (MC) vasculitis. METHODS This prospective cohort study included 30 patients (median age 59 years [53-66] and 57% of women) with HCV-MC vasculitis. PegIFNα/ribavirin (for 48 weeks) was associated with telaprevir (375 mg three times daily, for 12 weeks, [n = 17]) or boceprevir (800 mg three times daily, for 44 weeks, (n = 13]). RESULTS Twenty three patients (76.7%) were non-responders to previous antiviral therapy. At week 72, twenty patients (66.7%) were complete clinical and sustained virological responders. The cryoglobulin level decreased from 0.45 to 0 g/L (p<0.0001) and the C4 level increased from 0.09 to 0.14 g/L (p = 0.017). Complete clinical responders had a higher frequency of purpura (16/20 [80%] vs. 4/10 [40%], p = 0.045), and a trend towards lower frequency of neuropathy (9/20 (45%) vs. 8/10 [80%], p = 0.12) compared with partial responders. Serious adverse events occurred in 14 patients (46.6%) during the 72 weeks of follow-up. Twenty eight patients (93.3%) received erythropoietin, 14 (46.6%) had red blood cell transfusion and 2 (6.6%) received granulocyte stimulating agent. The baseline factors associated with serious adverse events included liver fibrosis (p = 0.045) and a low platelet count (p = 0.021). CONCLUSIONS The PegIFNα/ribavirin/protease inhibitor combination is highly effective in severe and/or refractory HCV-MC at the cost of frequent side effects. Baseline platelet count and liver fibrosis are useful in guiding treatment decisions.

DOI: 10.1016/j.jhep.2014.08.015

2 Figures and Tables

0204060201520162017
Citations per Year

82 Citations

Semantic Scholar estimates that this publication has 82 citations based on the available data.

See our FAQ for additional information.

Cite this paper

@article{Saadoun2015PegIFNribavirinproteaseIC, title={PegIFNα/ribavirin/protease inhibitor combination in severe hepatitis C virus-associated mixed cryoglobulinemia vasculitis.}, author={David Saadoun and Matthieu Resche Rigon and Stanislas Pol and Vincent Thibault and François Blanc and Gilles Pialoux and Alexandre Karras and Doroth{\'e}e Bazin-Kara and C{\'e}cile Cazorla and Daniel Vittecoq and Lucile Musset and Julie Peltier and Olivier Decaux and Jean-Marc Ziza and Olivier Lambotte and P Cacoub}, journal={Journal of hepatology}, year={2015}, volume={62 1}, pages={24-30} }