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Cryoglobulinemia vasculitis: how to handle
Anne C Desbois1, Cloe Comarmond, David Saadoun
1aSorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B) bINSERM, UMR_S 959 cCNRS, FRE3632 dAP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France.
Insights
New direct-acting antivirals (DAAs) offer a highly effective and safe treatment for hepatitis C virus (HCV)-associated cryoglobulinemia vasculitis (CryoVas), marking a significant advance in patient care.
Area of Science:
- Hepatology
- Immunology
- Rheumatology
Background:
- Hepatitis C virus (HCV) infection frequently leads to mixed cryoglobulinemia.
- Over two-thirds of patients with mixed cryoglobulinemia develop symptomatic cryoglobulinemia vasculitis (CryoVas).
Purpose of the Study:
- To review recent diagnostic and therapeutic advancements for HCV-associated CryoVas.
- To highlight the impact of novel antiviral therapies on managing this complication.
Main Methods:
- Review of current literature on HCV-CryoVas diagnosis and treatment.
- Analysis of recent clinical findings and consensus recommendations.
Main Results:
- Direct-acting antivirals (DAAs) have revolutionized HCV-CryoVas treatment, offering high cure rates and excellent safety.
- Interferon-free DAAs are now recommended as first-line therapy for most HCV-CryoVas patients.
- Immunosuppressive agents remain crucial for severe cases or when antiviral therapy is contraindicated.
Conclusions:
- DAAs provide a well-tolerated and definitive treatment for the majority of HCV-CryoVas patients.
- This represents a major clinical advancement, improving outcomes for a previously challenging complication.
Purpose Of Review:
More than 50% of hepatitis C virus (HCV) infected patients produce a mixed cryoglobulin and two-third of them will develop a symptomatic cryoglobulinemia vasculitis (CryoVas). In the present review, we aim at summarizing the most recent advances in diagnosis and treatment of HCV-CryoVas.
Recent Findings:
The treatment of HCV-CryoVas has much changed during the last months. The recent emergence of new direct-acting (DAA) interferon (IFN)-free antivirals, enabling high cure rates with a very good safety profile now permit to cure most patients with HCV-CryoVas. Multidisciplinary consensus recommends to consider IFN-free DAAs as first-line treatment for HCV-CryoVas patients. Immunosuppressive treatments (i.e. rituximab, glucocorticosteroids, cyclophosphamide and plasmapheresis) remain an interesting therapeutic approach, in severe form of HCV-CryoVas, failure or contradiction to antiviral treatments.
Summary:
The great efficacy of DAA on HCV-CryoVas represents a major advance in clinical practice, as these new antivirals provide for the first time a well tolerated and definite treatment of such complication for most patients.