Open AccessModes of antiviral therapy containing daclatasvir, when mixed cryoglobulinemia associated with chronic infection with
hepatitis C virus (multicentre study in the framework of individual access)
Author(s) -
В. Т. Ивашкин,
Dzhamal Abdurakhmanov,
И. Г. Бакулин,
M.L. Zubkin,
С. Н. Кижло,
M. B. Mayevskaya,
Olga Sagalova,
I. G. Kim,
V.I. Chervinko
Publication year - 2018
Publication title -
kliničeskaâ medicina
Language(s) - English
Resource type - Journals
eISSN - 2412-1339
pISSN - 0023-2149
DOI - 10.18821/0023-2149-2018-96-9-820-825
Subject(s) - medicine , daclatasvir , cryoglobulinemia , gastroenterology , asymptomatic , ribavirin , hepatitis c virus , cryoglobulins , hepatitis c , immunology , virus , antibody
Mixed cryoglobulinemia (MC) and cryoglobulinemic vasculitis (CV) are the most frequent extrahepatic manifestations in chronically infected hepatitis C virus (HCV) patients. Antiviral therapy with interferon and ribavirin used to play an important role in the complex of therapeutic measures in patients with CV. Modern direct-acting antiviral (DAA) drugs radically improved the results of treatment of uncomplicated chronic hepatitis C. This study evaluated the efficacy and safety of daclatasvircontaining regimens of antiviral therapy in asymptomatic MC and CV associated with chronic HCV infection. The study included 25 HCV-infected patients with MC at the age of 53.9 ± 11.6 years. The genotype of virus 1b was determined in 21 (84%) of patients, genotype 3 - in 4 (16%) of them. The stage of fibrosis (F) 4 on the METAVIR scale was diagnosed in 23 (92%) patients. Patients with genotype 1b received a combination of daclatasvir with asunaprevir, and with genotype 3 - daclatasvir with sophosbuvir. In the study group 8 patients had asymptomatic MC and 17 patients had CV. Among 17 patients with vasculitis, 6 had purpura; in part - in combination with arthralgia and polyneuropathy. In 11 patients, in addition to these symptoms, internal organs, mainly the kidneys, were also affected. A sustained virologic response was in 96%. A complete clinical response in patients with CV was achieved in 67% of patiernts, and remission of glomerulonephritis was found in 56% of patients. The disappearance of cryoglobulins was observed in 29% of all cases of MC, normalization of rheumatoid factor level in 71%, and C4 complement component in 50% of patients. Daclatasvir-containing regimens for antiviral therapy of HCV-associated MC have high efficacy in eliminating of the virus, while clinical and immunological responses, especially the disappearance of cryoglobulins, have been observed less frequently. Adverse effects were minimal and very rare.