Efficacy of direct-acting antivirals in patients with HCV-associated cryoglobulinemia and monoclonal gammapathy

Gavrisheva S.: Lomonosov Moscow State University

Abdurakhmanov D.T.: Department of Internal, Occupational diseases and Rheumatology, Sechenov University, Moscow

Bulanov N.: Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia

Tanaschuk E.L.: Department of Internal, Occupational diseases and Rheumatology, Sechenov University, Moscow

Rozina T.P.: Department of Internal, Occupational diseases and Rheumatology, Sechenov University, Moscow

Nikulkina E.N.: Department of Internal, Occupational diseases and Rheumatology, Sechenov University, Moscow

Milovanova S.: Sechenov First Moscow State Medical University, Moscow, Russia

Filatova A.: Lomonosov Moscow State University

Krasnova T.N.: Lomonosov Moscow State University, Moscow

Starostina E.E.: Tareev Clinic of Internal Diseases, Sechenov University, Moscow, Russia

Avdeev V.: Lomonosov Moscow State University

Novikov P.: Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia

Moiseev S.: Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia

Download in PDF

Summary

Aim

To evaluate the efficacy of direct-acting antivirals (DAA) in patients with hepatitis C virus (HCV) associated cryoglobulinemia and monoclonal gammapathy (MG).

Material and methods

In a retrospective study, we enrolled 10 patients with HCV-associated cryoglobulinemia (asymptomatic in 1 and cryoglobulinemic vasculitis in 9) and MG who received treatment with DAA ± immunosuppressive agents. We studied the rate of sustained virological response, cryoglobulins and MG elimination and development of lymphoproliferative and plasma cells disorders. In patients with cryoglobulinemic vasculitis the rate of clinical response was also evaluated.

Results

All patients have achieved a sustained virological response and were followed for a median of 62.0 months (45.5-74.9) after DAA therapy. All 9 patients with cryoglobulinemic vasculitis responded to treatment, although 2 of 6 patients treated with DAA only have relapsed later and required immunosuppressive therapy. Cryoglobulinemia was eliminated in 9 (90%) of 10 patients. However, 4 (40%) and 6 (60%) patients, respectively, presented with positive rheumatoid factor and low C4 complement after treatment. MG elimination was achieved in 7 (70%) patients. One of 3 patients with persisting MG developed Waldenstrom macrolgobulinemia within 2 years after antiviral therapy.

Conclusion

Treatment with DAA ± immunosuppressive agents resulted in sustained virological response, clinical response and MG elimination in most patients with HCV-associated cryoglobulinemia and MG. Monoclonal paraprotein secretion should be monitored in patients with MG that persists after antiviral therapy.

Key words

Cryoglobulinemia, cryoglobulinemic vasculitis, direct-acting antivirals, hepatitis C, monoclonal gamma - pathy.