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Treatment of hepatitis C virus infection in patients with mixed cryoglobulinemic syndrome and cryoglobulinemic glomerulonephritis
Author(s) -
Rutledge Stephanie M.,
Chung Raymond T.,
Sise Meghan E.
Publication year - 2018
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12649
Subject(s) - medicine , cryoglobulinemia , ribavirin , hepatitis c virus , gastroenterology , cryoglobulins , hepatitis c , boceprevir , immunology , virus , antibody
Cryoglobulinemia is a common extrahepatic manifestation of infection with hepatitis C virus (HCV). When signs and symptoms of systemic vasculitis or glomerulonephritis occur in the presence of circulating cryoglobulins, this syndrome is called “mixed cryoglobulinemia syndrome” (MCS). Historically, interferon‐based therapies in HCV have been associated with lower rates of viral cure in patients with MCS than in the general HCV‐infected population. The advent of direct‐acting antiviral therapies have revolutionized the treatment of HCV, dramatically increasing rates of cure. Early studies of first‐generation protease inhibitors (telaprevir and boceprevir) in combination with interferon and ribavirin demonstrated HCV cure rates of 67% and complete clinical response rates of vasculitis symptoms in 60% of patients with MCS; however, regimens were poorly tolerated by patients, 22% discontinued treatment early. More recently, all‐oral, interferon‐free regimens have become available and combination therapies are now being approved for patients with and without renal impairment. Patients with HCV‐MCS achieved sustained virologic response in 297 out of 313 patients (95%) treated with direct‐acting antiviral therapy, and 85% had a complete or partial clinical response of MCS symptoms. Current direct‐acting antiviral therapies are well tolerated in patients with HCV‐MCS and only 1.6% discontinued treatment early. Patients with cryoglobulinemic glomerulonephritis also had an excellent cure rate (94%). The majority improved; 17/52 (33%) experienced full remission and 15/52 (29%) experienced partial remission. There were no reports of worsening kidney function in patients treated with direct‐acting antiviral therapies. Less than 5% of patients with HCV‐MCS treated with IFN‐free direct‐acting antiviral therapy required immunosuppression. However, patients with severe vasculitis appear to still require concomitant immunosuppression.