[Superiority of a new etiopathogenic treatment curing periarteritis nodosa caused by hepatitis B virus, using a combination of brief corticotherapy, vidarabine and plasma exchange].

A new physiopathological treatment of HBV-related polyarteritis inspired by advances in the treatment of chronic active hepatitis B was tested in 7 patients. The new protocol included short term corticosteroid therapy, a course of antiviral chemotherapy with vidarabine and repeated plasma exchanges enabling steroids to be discontinued after 2 weeks. This treatment was well tolerated, and 6 of the 7 patients treated were clinically, biologically and virologically cured. The eradication of HBV among the patients who were cured was confirmed by clearance of HBs Ag and its replacement by anti HBs. None of the 6 patients relapsed during a 2 to 7 years' follow-up. The seventh patient died. In contrast, no patient had been cured in a similar group of 7 polyarteritis patients previously treated with the conventional symptomatic therapy using corticosteroids (6/7), plasma exchanges (4/7) and immunosuppressants (2/7). The outcome in this older series followed up for 3 years was altogether unfavourable, with 3 deaths, 3 chronic forms with multiple relapses and 1 spontaneous stabilisation. All patients remained chronic carriers of HBV. These results suggest that the new aetiopathogenic treatment capable of curing polyarteritis patients should replace the classical symptomatic treatment as soon as these preliminary results are confirmed by those of a multicentre study in progress.