Gragnani Laura, Fabbrizzi Alessio, Triboli Elisa, Urraro Teresa, Boldrini Barbara, Fognani Elisa, Piluso Alessia, Caini Patrizio, Ranieri Jessica, Monti Monica, Laffi Giacomo, Zignego Anna Linda
Center for Systemic Manifestations of Hepatitis Viruses (MASVE), Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Center for Systemic Manifestations of Hepatitis Viruses (MASVE), Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Dig Liver Dis. 2014 Sep;46(9):833-7. doi: 10.1016/j.dld.2014.05.017. Epub 2014 Jun 19.
Mixed cryoglobulinaemia is strongly related to hepatitis C virus infection. Treatment with peg-interferon and ribavirin has been indicated as first-line therapy for mild/moderate hepatitis C virus-related mixed cryoglobulinaemia.
To evaluate the safety and efficacy of triple boceprevir-based antiviral therapy in patients with or without mixed cryoglobulinaemia previously treated with peg-interferon and ribavirin, and with advanced liver disease.
Thirty-five hepatitis C virus-positive patients (17 with asymptomatic mixed cryoglobulinaemia, 5 with symptomatic mixed cryoglobulinaemia, and 11 without mixed cryoglobulinaemia) were treated with triple boceprevir-based antiviral therapy.
In 19/22 cryoglobulinaemic subjects (86%), the addition of boceprevir induced cryocrit disappearance. Cryocrit behaviour was related to virological response, with improvement of symptoms upon undetectable viraemia and reappearance after virological breakthrough. The rate of sustained virological response was lower in cryoglobulinaemic patients than in patients without mixed cryoglobulinaemia (23.8% vs 70% respectively, p=0.01).
Boceprevir-based therapy was safe and effective in cryoglobulinaemic patients. The correlation between direct inhibition of hepatitis C virus replication and clinical improvement in mixed cryoglobulinaemic patients is definitive proof of the key pathogenetic role played by viral replication. Further studies are needed to confirm and clarify the reduced virological response in patients with mixed cryoglobulinaemia.
混合性冷球蛋白血症与丙型肝炎病毒感染密切相关。聚乙二醇干扰素和利巴韦林治疗已被指定为轻度/中度丙型肝炎病毒相关混合性冷球蛋白血症的一线治疗方法。
评估基于波普瑞韦的三联抗病毒疗法在曾接受聚乙二醇干扰素和利巴韦林治疗且患有晚期肝病的混合性冷球蛋白血症患者或无混合性冷球蛋白血症患者中的安全性和疗效。
35例丙型肝炎病毒阳性患者（17例无症状混合性冷球蛋白血症患者、5例有症状混合性冷球蛋白血症患者和11例无混合性冷球蛋白血症患者）接受了基于波普瑞韦的三联抗病毒治疗。
在19/22例冷球蛋白血症患者（86%）中，添加波普瑞韦导致冷球蛋白血症消失。冷球蛋白血症情况与病毒学反应相关，病毒血症检测不到时症状改善，病毒学突破后症状再现。冷球蛋白血症患者的持续病毒学应答率低于无混合性冷球蛋白血症的患者（分别为23.8%和70%，p=0.01）。
基于波普瑞韦的治疗对冷球蛋白血症患者安全有效。丙型肝炎病毒复制的直接抑制与混合性冷球蛋白血症患者临床改善之间的相关性明确证明了病毒复制所起的关键致病作用。需要进一步研究以确认并阐明混合性冷球蛋白血症患者病毒学应答降低的情况。
