Antiviral therapy for hepatitis C virus–associated mixed cryoglobulinemia vasculitis: A long‐term followup study

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Abstract
Objective To evaluate the long‐term efficacy of anti–hepatitis C virus (HCV) therapy in patients with HCV‐associated mixed cryoglobulinemia (HCV‐MC) vasculitis and to assess the factors associated with clinical remission of MC. Methods This was a single‐center study of 72 consecutive patients who received treatment with IFN alfa‐2b (3 million IU 3 times a week; n = 32 patients) or PEGylated IFN alfa‐2b (PEG–IFN alfa‐2b) (1.5 μg/kg/week; n = 40 patients), both in combination with oral ribavirin (600–1,200 mg/day), for at least 6 months. Logistic regression was used to assess factors associated with clinical remission of MC. Results The mean ± SD duration of followup after discontinuation of antiviral therapy was 39.7 ± 24.4 months. Eight deaths (11.1% of patients) occurred during the study, primarily as a result of cardiovascular disease, liver disease, or infection. A complete clinical response of the MC occurred in 45 patients (62.5%), a sustained virologic response occurred in 58.3%, and cryoglobulins cleared in 45.8%. Compared with patients treated with IFN alfa‐2b plus ribavirin, those receiving PEG–IFN alfa‐2b plus ribavirin had a higher sustained clinical (67.5% versus 56.3%), virologic (62.5% versus 53.1%), and immunologic (57.5% versus 31.3%) response, regardless of HCV genotype and viral load. In multivariate analyses, an early virologic response (odds ratio 3.53 [95% confidence interval 1.18–10.59]) was independently associated with a complete clinical response of MC. A glomerular filtration rate ≤70 ml/minute (odds ratio 0.18 [95% confidence interval 0.05–0.67]) was negatively associated with a complete clinical response of MC. Conclusion PEG–IFN alfa‐2b plus ribavirin should be considered as induction therapy for HCV‐MC vasculitis. An early virologic response and the absence of renal insufficiency are the key factors in the clinical response.