Document Detail


Safety and efficacy of rituximab in patients with hepatitis C virus-related mixed cryoglobulinemia and severe liver disease.
MedLine Citation:
PMID:  20308604     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The effectiveness of rituximab in hepatitis C virus (HCV)-related mixed cryoglobulinemia (MC) has been shown. However, the risk of an increase in viral replication limits its use in cirrhosis, a condition frequently observed in patients with MC. In this prospective study, 19 HCV-positive patients with MC and advanced liver disease, who were excluded from antiviral therapy, were treated with rituximab and followed for 6 months. MC symptoms included purpura, arthralgias, weakness, sensory-motor polyneuropathy, nephropathy, and leg ulcers. Liver cirrhosis was observed in 15 of 19 patients, with ascitic decompensation in 6 cases. A consistent improvement in MC syndrome was evident at the end-of-treatment (EOT) and end-of-follow-up (EOF-U). Variable modifications in both mean viral titers and alanine aminotransferase values were observed at admission, EOT, third month of follow-up, and EOF-U (2.62 x 10(6), 4.28 x 10(6), 4.82 x 10(6), and 2.02 x 10(6) IU/mL and 63.6, 49.1, 56.6, and 51.4 IU/L, respectively). Improvement in liver protidosynthetic activity and ascites degree was observed at EOT and EOF-U, especially in more advanced cases. This study shows the effectiveness and safety of rituximab in MC syndrome with advanced liver disease. Moreover, the depletion of CD20(+) B cells was also followed by cirrhosis syndrome improvement despite the possibility of transient increases of viremia titers.
Authors:
Antonio Petrarca; Luigi Rigacci; Patrizio Caini; Stefano Colagrande; Paolo Romagnoli; Francesco Vizzutti; Umberto Arena; Carlo Giannini; Monica Monti; Paolo Montalto; Marco Matucci-Cerinic; Alberto Bosi; Giacomo Laffi; Anna Linda Zignego
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-03-22
Journal Detail:
Title:  Blood     Volume:  116     ISSN:  1528-0020     ISO Abbreviation:  Blood     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-23     Completed Date:  2010-08-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7603509     Medline TA:  Blood     Country:  United States    
Other Details:
Languages:  eng     Pagination:  335-42     Citation Subset:  AIM; IM    
Affiliation:
Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), Department of Internal Medicine, University of Florence, Florence, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Antibodies, Monoclonal / adverse effects,  therapeutic use*
B-Lymphocytes / immunology
Cryoglobulinemia / drug therapy*,  etiology*,  immunology
Female
Hepatitis C, Chronic / complications*,  drug therapy*,  virology
Humans
Immunosuppressive Agents / adverse effects,  therapeutic use
Liver Cirrhosis / drug therapy*,  etiology*,  pathology
Male
Middle Aged
Mononuclear Phagocyte System / pathology
Prospective Studies
RNA, Viral / blood
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Immunosuppressive Agents; 0/RNA, Viral; 0/rituximab

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