Reuters Health Information (2008-10-09): Rituximab plus ribavirin/interferon effective against hepatitis C-related vasculitis
Rituximab plus ribavirin/interferon effective against hepatitis C-related vasculitis
Last Updated: 2008-10-09 15:30:51 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Rituximab combined with ribavirin and interferon alpha-2b is a safe and effective treatment for severe refractory mixed cryoglobulinemia vasculitis associated with hepatitis C virus (HCV) infection, according to a pilot study by French researchers reported in the October issue of the Annals of the Rheumatic Diseases.
Research published over the past 5 years indicates that rituximab is effective against cryoglobulin production and the resulting inflammatory vascular lesions, the authors note. Nonetheless, about 30% of patients with mixed cryoglobulinemia (MC) continue to have active disease while receiving treatment with anti-CD20 monoclonal antibody or an antiviral.
Dr. Patrice Cacoub of the Universite Pierre et Marie Curie, Paris, and colleagues therefore examined whether combining rituximab with pegylated interferon alpha and ribavirin would be more effective.
The researchers studied 16 consecutive patients with HCV-associated MC who either were resistant to treatment with interferon alpha-2b (standard or pegylated) and ribavirin or had relapsed following it.
Treatment consisted of an intravenous infusion of rituximab 375 mg/m� once a week for 4 weeks, followed 1 month later by Peg-IFNa2b plus ribavirin for 12 months.
Based on assessments made an average of 6 months after completion of treatment, 10 of the 16 patients had a complete clinical response, with improvement in all baseline clinical manifestations, such as arthralgia and peripheral neuropathy. Five were partial responders and 1 was a non-responder.
Leg ulcers resolved in all patients, and purpura improved in 84.6%, arthralgia in 83.4%, renal involvement in 57.2% and polyneuropathy in 38.4%.
Only two patients experienced significant side effects -- worsening of peripheral neuropathy or a flare-up of skin psoriasis in one patient each.
"Taken together these data suggest that rituximab combined with Peg-IFNa-ribavirin may act synergistically and represents a good treatment strategy in patients with HCV-MC with severe organ involvement," Dr. Cacoub and colleagues conclude.
The researchers also noted that the duration of MC disease was a significant predictive factor. "The duration of MC vasculitis before treatment in the partial or non-responders was 3.6 times longer than in the complete clinical responders."
Ann Rheum Dis 2008;67:1431-1436.