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DAAs safe, effective in patients with HCV, mixed cryoglobulinemia

Direct-acting antiviral use resulted in high rates of sustained virologic response and were safely tolerated in patients with chronic hepatitis C and mixed cryoglobulinemia, according to a recently published study. Researchers observed that most patients did not have a complete clinical or immunological response, however, suggesting a delayed response.

“Our study showed that achievement of SVR was necessary but not sufficient to obtain a complete immunological or clinical response,” Joel S. Emery, MD, from the University of Toronto, and colleagues wrote. “Although the viral trigger for lymphocyte clonal expansion may be removed (virological response), time-dependent clearance or downregulation of autoimmune B-cell populations is likely necessary before significant immunological or clinical improvements are seen.”

Between August 2011 and December 2015, 83 patients with hepatitis C and mixed cryoglobulinemia received treatment at the researchers’ center. Baseline characteristics were mostly similar between the 65 asymptomatic patients and 18 symptomatic patients. Sixty-six patients received interferon-free treatment.

The asymptomatic patients and symptomatic patients had similar rates of overall sustained virologic response (59 vs. 16). The success rates for interferon-free and interferon-containing regimens were also similar (92.4% vs. 82.4%); however, there were significantly more medication-related adverse events and treatment modifications required among patients receiving interferon (29.4% vs. 4.5%; P = .008).

Of the 68 patients with available immunological outcomes, 31 achieved SVR and had a complete immunological response, including 26 asymptomatic patients and 5 symptomatic patients. One asymptomatic patient had a complete immunological response, but did not achieve SVR. Four symptomatic patients who did not respond to therapy showed reappearance of cryoglobulins at the time of virological relapse.

Seven patients had severe mixed cryoglobulinemia vasculitis and six of those achieved SVR. Among those who achieved SVR, one had a complete clinical response, three had a partial response and two showed no improvement.

“The current study shows that DAA are highly effective in achieving SVR and can have significant impacts on immunological and clinical outcomes in patients with [mixed cryoglobulinemia]. However, robust virological responses do not guarantee rapid clinical responses,” the researchers wrote. “Close follow-up is essential in the era of shorter treatment durations as relapse may occur and rescue therapies that target B-cell dysregulation may still be required.” – by Talitha Bennett

Disclosure: Emery reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.