Triple antiviral therapy in hepatitis C virus infection with or without mixed cryoglobulinaemia: A prospective, controlled pilot study

被引：57

作者：

Gragnani, Laura ^{[1
]}

Fabbrizzi, Alessio ^{[1
]}

Triboli, Elisa ^{[1
]}

Urraro, Teresa ^{[1
]}

Boldrini, Barbara ^{[1
]}

Fognani, Elisa ^{[1
]}

Piluso, Alessia ^{[1
]}

Caini, Patrizio ^{[1
]}

Ranieri, Jessica ^{[1
]}

Monti, Monica ^{[1
]}

Laffi, Giacomo ^{[1
]}

Zignego, Anna Linda ^{[1
]}

机构：

[1] Univ Florence, Dept Expt & Clin Med, Ctr Syst Manifestat Hepatitis Viruses MASVE, I-50134 Florence, Italy

来源：

DIGESTIVE AND LIVER DISEASE | 2014年 / 46卷 / 09期

关键词：

Antiviral therapy; Direct-acting antiviral; Hepatitis C virus; Mixed cryoglobulinaemia; INTERFERON-ALPHA; HCV INFECTION; RITUXIMAB; MANAGEMENT; RIBAVIRIN; CIRRHOSIS;

D O I：

10.1016/j.dld.2014.05.017

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background: Mixed cryoglobulinaemia is strongly related to hepatitis C virus infection. Treatment with peg-interferon and ribavirin has been indicated as first-line therapy for mild/moderate hepatitis C virus-related mixed cryoglobulinaemia. Aim: To evaluate the safety and efficacy of triple boceprevir-based antiviral therapy in patients with or without mixed cryoglobulinaemia previously treated with peg-interferon and ribavirin, and with advanced liver disease. Methods: Thirty-five hepatitis C virus-positive patients (17 with asymptomatic mixed cryoglobulinaemia, 5 with symptomatic mixed cryoglobulinaemia, and 11 without mixed cryoglobulinaemia) were treated with triple boceprevir-based antiviral therapy. Results: In 19/22 cryoglobulinaemic subjects (86%), the addition of boceprevir induced cryocrit disappearance. Cryocrit behaviour was related to virological response, with improvement of symptoms upon undetectable viraemia and reappearance after virological breakthrough. The rate of sustained virological response was lower in cryoglobulinaemic patients than in patients without mixed cryoglobulinaemia (23.8% vs 70% respectively, p = 0.01). Conclusion: Boceprevir-based therapy was safe and effective in cryoglobulinaemic patients. The correlation between direct inhibition of hepatitis C virus replication and clinical improvement in mixed cryoglobulinaemic patients is definitive proof of the key pathogenetic role played by viral replication. Further studies are needed to confirm and clarify the reduced virological response in patients with mixed cryoglobulinaemia. (C) 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

引用

页码：833 / 837

页数：5

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