Results of a recent study showed that sustained virologic response after treatment with direct-acting antivirals correlated with an increased control of vasculitic manifestations in patients with hepatitis C-associated cryoglobulinemic vasculitis, although some patients may relapse.
“Patients with hepatitis C virus-associated cryoglobulinemic vasculitis (HCV-CV) have high rates of clinical remission after treatment with direct-acting antivirals (DAAs), but circulating cryoglobulins persist and vascular disorders reappear in some patients shortly after DAA treatment ends,” Martín Bonacci, MD, PhD, from the University of Barcelona, Spain, and colleagues wrote. “Long-term monitoring of HCV-CV patients is required after SVR12.”
In a prospective study, Bonacci and colleagues evaluated 46 patients who had HCV-CV and 42 patients who had HCV and asymptomatic circulating cryoglobulins (ACC) for a median of 24 months (range, 17-41 months) after the patients achieved SVR.
Complete clinical response increased from 70% at SVR to 80% at follow-up among the total cohort and partial response increased from 9% to 11%. Cryoglobulins persisted positive in 59% of patients with HCV-CV and 45% of patients with ACC, which decreased to 20% in both groups at follow-up.
Overall, complete immunologic response increased from 39% at SVR to 66% at follow-up in patients with HCV-CV and from 50% at SVR to 70% at follow-up in patients with ACC (P < .05). The researchers observed no difference in clinical or immunological outcomes related to DAA therapy duration or treatment regimen.
While most vasculitic manifestations resolved or improved during follow-up, five patients presented vasculitis relapse, four of whom had underlying cirrhosis.
“Our study shows that HCV eradication is associated with an increased control of vasculitic manifestations throughout an extensive follow-up. Thus, immunosuppressive therapy would be only necessary in difficult-to-treat cases,” Bonacci and colleagues wrote. “Although immune activation parameters improve significantly overtime after HCV cure, cryoglobulins may persist in [approximately] 20% of patients up to 2 years after viral cure.”
The researchers note that while it was not clear why some patients relapsed, most of those who relapsed had underlying cirrhosis, which may be associated with the decreased ability to eliminate immune-complexes due to liver impairment. – by Talitha Bennett
Disclosure: The authors report no relevant financial disclosures.