Presentation: Rituximab Combined with Peg-Interferon-Ribavirin in Refractory Hcv-Associated Cryoglobulinemia Vasculitis (2007)

2025 Rituximab Combined with Peg-Interferon-Ribavirin in Refractory Hcv-Associated Cryoglobulinemia Vasculitis

Background: Treatment of hepatitis C-related mixed cryoglobulinemia (HCV-MC) remains difficult and one-third of patients continue to have active disease while receiving anti-CD20 monoclonal antibody or antiviral therapy.
Objective: To report the results of a prospective open study using rituximab combined with Peg-Interferon (IFN)α2b-ribavirin in HCV-MC vasculitis.
Patients: Sixteen consecutive HCV-MC patients were treated with rituximab (375mg/m² intravenously weekly for 4 weeks) combined with Peg-IFNα2b-ribavirin (for 12 months). All patients had severe active disease which was resistant to previous combination antiviral therapy.
Results: Fifteen patients (93.7%) showed rapid clinical improvement, 10 of whom (62.5%) were complete responders. Compared with clinical complete responders, the partial or non responders had a 3.6 times longer duration of vasculitis prior to therapy and a lower rate of early virologic response. Complete response was associated with a significant reduction of cryoglobulin, rheumatoid factor activity and HCV RNA and increased C4. Treatment was well tolerated with no infectious complications. Flare-up of psoriasis and worsening of peripheral neuropathy occurred in one patient each. Clinical relapse occurred in two patients, which was associated with the simultaneous reappearance of HCV RNA and cryoglobulin and an increase in the number of peripheral blood B-cells.
Conclusion: Rituximab combined with Peg-IFNα2b-ribavirin may act synergistically and represents a safe and effective therapeutic option in severe HCV-MC. This therapeutic schedule should be considered as induction therapy for HCV-MC patients.

 D. Saadoun, None; M. Resche-Rigon, None; D. Sene, None; L. Perard, None; J. Piette, None; P. Cacoub, None.

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