Background and Aims: Mixed cryoglobulinemia is the most common HCV extrahepatic manifestation. We aimed to prospectively evaluate the cryoglobulinemic vasculitis (CV) clinical profile after a sustained virologic response (SVR) over a medium-term to long-term period. Approach and Results: Direct-acting antiviral–treated cryoglobulinemic patients, consecutively enrolled in the multicentric Italian Platform for the Study of Viral Hepatitis Therapy cohort, were prospectively evaluated. Cumulative incidence Kaplan-Meier curves were reported for response, clinical deterioration, relapse and relapse-free survival rates. Cox regression analysis evaluated factors associated with different outcomes. A clinical response was reported in at least one follow-up point for 373 of 423 (88%) patients with CV who achieved SVR. Clinical response increased over time with a 76% improvement rate at month 12 after the end of treatment. A full complete response (FCR) was reached by 164 (38.8%) patients in at least one follow-up point. CV clinical response fluctuated, with some deterioration of the initial response in 49.6% of patients (median time of deterioration, 19 months). In patients who achieved FCR and had an available follow-up (137 patients) a relapse was observed in 13% and it was transient in 66.7% of patients. The rate of patients without any deterioration was 58% and 41% at 12 and 24 months, respectively. After achieving SVR, a clinical nonresponse was associated with older age and renal involvement; a clinical deterioration/relapse was associated with high pretreatment rheumatoid factor values, and FCR was inversely associated with age, neuropathy, and high cryocrit levels. Conclusion: In patients with CV, HCV eradication may not correspond to a persistent clinical improvement, and clinical response may fluctuate. This implies an attentive approach to post-SVR evaluation through prognostic factors and tailored treatment.

A prospective study of direct-acting antiviral effectiveness and relapse risk in HCV cryoglobulinemic vasculitis by the Italian PITER cohort / Kondili, L. A.; Monti, M.; Quaranta, M. G.; Gragnani, L.; Panetta, V.; Brancaccio, G.; Mazzaro, C.; Persico, M.; Masarone, M.; Gentile, I.; Andreone, P.; Madonia, S.; Biliotti, E.; Filomia, R.; Puoti, M.; Fracanzani, A. L.; Laccabue, D.; Ieluzzi, D.; Coppola, C.; Rumi, M. G.; Benedetti, A.; Verucchi, G.; Coco, B.; Chemello, L.; Iannone, A.; Ciancio, A.; Russo, F. P.; Barbaro, F.; Morisco, F.; Chessa, L.; Massari, M.; Blanc, P.; Zignego, A. L.. - In: HEPATOLOGY. - ISSN 0270-9139. - 76:1(2022), pp. 220-232. [10.1002/hep.32281]

A prospective study of direct-acting antiviral effectiveness and relapse risk in HCV cryoglobulinemic vasculitis by the Italian PITER cohort

Andreone P.;
2022

Abstract

Background and Aims: Mixed cryoglobulinemia is the most common HCV extrahepatic manifestation. We aimed to prospectively evaluate the cryoglobulinemic vasculitis (CV) clinical profile after a sustained virologic response (SVR) over a medium-term to long-term period. Approach and Results: Direct-acting antiviral–treated cryoglobulinemic patients, consecutively enrolled in the multicentric Italian Platform for the Study of Viral Hepatitis Therapy cohort, were prospectively evaluated. Cumulative incidence Kaplan-Meier curves were reported for response, clinical deterioration, relapse and relapse-free survival rates. Cox regression analysis evaluated factors associated with different outcomes. A clinical response was reported in at least one follow-up point for 373 of 423 (88%) patients with CV who achieved SVR. Clinical response increased over time with a 76% improvement rate at month 12 after the end of treatment. A full complete response (FCR) was reached by 164 (38.8%) patients in at least one follow-up point. CV clinical response fluctuated, with some deterioration of the initial response in 49.6% of patients (median time of deterioration, 19 months). In patients who achieved FCR and had an available follow-up (137 patients) a relapse was observed in 13% and it was transient in 66.7% of patients. The rate of patients without any deterioration was 58% and 41% at 12 and 24 months, respectively. After achieving SVR, a clinical nonresponse was associated with older age and renal involvement; a clinical deterioration/relapse was associated with high pretreatment rheumatoid factor values, and FCR was inversely associated with age, neuropathy, and high cryocrit levels. Conclusion: In patients with CV, HCV eradication may not correspond to a persistent clinical improvement, and clinical response may fluctuate. This implies an attentive approach to post-SVR evaluation through prognostic factors and tailored treatment.
2022
76
1
220
232
A prospective study of direct-acting antiviral effectiveness and relapse risk in HCV cryoglobulinemic vasculitis by the Italian PITER cohort / Kondili, L. A.; Monti, M.; Quaranta, M. G.; Gragnani, L.; Panetta, V.; Brancaccio, G.; Mazzaro, C.; Persico, M.; Masarone, M.; Gentile, I.; Andreone, P.; Madonia, S.; Biliotti, E.; Filomia, R.; Puoti, M.; Fracanzani, A. L.; Laccabue, D.; Ieluzzi, D.; Coppola, C.; Rumi, M. G.; Benedetti, A.; Verucchi, G.; Coco, B.; Chemello, L.; Iannone, A.; Ciancio, A.; Russo, F. P.; Barbaro, F.; Morisco, F.; Chessa, L.; Massari, M.; Blanc, P.; Zignego, A. L.. - In: HEPATOLOGY. - ISSN 0270-9139. - 76:1(2022), pp. 220-232. [10.1002/hep.32281]
Kondili, L. A.; Monti, M.; Quaranta, M. G.; Gragnani, L.; Panetta, V.; Brancaccio, G.; Mazzaro, C.; Persico, M.; Masarone, M.; Gentile, I.; Andreone, P.; Madonia, S.; Biliotti, E.; Filomia, R.; Puoti, M.; Fracanzani, A. L.; Laccabue, D.; Ieluzzi, D.; Coppola, C.; Rumi, M. G.; Benedetti, A.; Verucchi, G.; Coco, B.; Chemello, L.; Iannone, A.; Ciancio, A.; Russo, F. P.; Barbaro, F.; Morisco, F.; Chessa, L.; Massari, M.; Blanc, P.; Zignego, A. L.
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