Effectiveness of direct-acting antiviral (DAA) agents on hepatitis C virus-related mixed cryoglobulinemia syndrome: One-year follow-up

Background

Mixed cryoglobulinemia syndrome (MCS) is a systemic vasculitis involving skin, joints, kidneys, and peripheral nerves. Hepatitis C virus (HCV) is a well-known etiologic agent. Therapy for HCV has been revolutionized by the approval of direct-acting antiviral (DAA) agents.

Aim of the work

To evaluate the effect of the new DAA treatment on MCS in HCV-infected patients. A prospective study with one year follow-up after induction therapy was undergone.

Patients and methods

Sixty patients with HCV-infection having ≥ 1 extrahepatic manifestations and attending the Rheumatology outpatient at Kasr Alainy for treatment of immune-mediated disease were included. Patients were examined at baseline (before receiving HCV treatment), after six months, and after one year following receiving HCV treatment by sofosbuvir based regimen in specialized centers. All patients were treatment-naïve; Assessment for arthritis, vasculitis and nephritis was performed.

Results

Patients’ mean age was 51.1 ± 8.8 (30–68) years; 44 females and 16 males (F:M 2.8:1). Arthritis was present in 43 (71.6 %), cutaneous vasculitis in 30 (50 %): purpura in 19 (31.7 %), skin ulcers in 18 (30 %), peripheral neuropathy in 16 (26.7 %), and nephritis in 14(23.3 %) patients. Absolute viral clearance was sustained up to one year follow-up. The frequency of patients affected with MCS-related manifestations arthritis, cutaneous vasculitis, peripheral neuropathy, and nephritis tended to decrease. CDAI significantly decreased at six months compared to baseline (p = 0.04). BVAS, numeric rating scale (NRS) for neuropathic pain/paresthesia and proteinuria insignificantly changed from baseline at six months and at one-year (p = 0.28, p = 0.58 and p = 0.96 respectively).

Conclusion

Clinical and immunological responses for MCS-related manifestations were less satisfactory than the virologic response.