Peg-IFNα/ribavirin/protease inhibitor combination in hepatitis C virus associated mixed cryoglobulinemia vasculitis: results at week 24 - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Annals of the Rheumatic Diseases Année : 2014

Peg-IFNα/ribavirin/protease inhibitor combination in hepatitis C virus associated mixed cryoglobulinemia vasculitis: results at week 24

M. Resche Rigon
  • Fonction : Auteur
M. Longuet
  • Fonction : Auteur
F. Blanc
  • Fonction : Auteur
G. Pialoux
  • Fonction : Auteur
A. Karras
  • Fonction : Auteur
D. Bazin-Karra
  • Fonction : Auteur
D. Vittecoq
  • Fonction : Auteur
L. Musset
  • Fonction : Auteur
J. M. Ziza
  • Fonction : Auteur
O. Lambotte
  • Fonction : Auteur

Résumé

BACKGROUND: The standard-of-care treatment of patients with hepatitis C virus (HCV)-mixed cryoglobulinemia (MC) vasculitis includes pegylated interferon α (PegIFN)-α plus ribavirin and/or rituximab. About 30-40% of patients are non-responders or relapsers to such combination. OBJECTIVE: To analyse the safety and efficacy of Peg-IFNα/ribavirin/protease inhibitor combination in HCV-MC vasculitis. PATIENTS AND METHODS: Open-label, prospective, cohort study including 23 patients with HCV-MC vasculitis. Peg-IFNα/ribavirin was associated to telaprevir (375 mg three times daily, for 12 weeks, (n=15)) or boceprevir (800 mg three times daily, for 44 weeks, (n=8)) for 48 weeks. RESULTS: The median age was 59 (52.5-66) years, with 48.8% women. Thirteen patients (56.5%) were complete clinical responders, and 10 (43.5%) were partial responders at week 24. The virological response (ie, HCV RNA negativation) was of 69.6% at week 24 (p=0.005). The cryoglobulin level decreased from 0.44 to 0.06 g/l (p=0.0006) and the C4 level increased from 0.09 to 0.15 g/l (p=0.045). Grades 3 and 4 adverse events (mainly anaemia, neutropenia and thrombocytopenia) were observed in 10 cases (43.5%). Twenty patients (87%) received erythropoietin, 9 (39.1%) had red cell transfusion, and 2 (8.7%) had granulocyte stimulating agents. Antiviral therapy discontinuation was required in 8 (34.7%) patients for virological non-response (n=5), virological relapse (n=2) and depression (n=1). CONCLUSIONS: Peg-IFNα/ribavirin/protease inhibitor combination seems highly effective in HCV-MC. Such therapeutic regimen should be administered cautiously considering the high rate of side effects.

Dates et versions

hal-01068010 , version 1 (24-09-2014)

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David Saadoun, M. Resche Rigon, Valérie Thibault, M. Longuet, S. Pol, et al.. Peg-IFNα/ribavirin/protease inhibitor combination in hepatitis C virus associated mixed cryoglobulinemia vasculitis: results at week 24. Annals of the Rheumatic Diseases, 2014, 73 (5), pp.831--837. ⟨10.1136/annrheumdis-2012-202770⟩. ⟨hal-01068010⟩
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