Patients with
chronic hepatitis C virus (HCV) can develop systemic cryoglobulinemic
vasculitis. Combination of pegylated-
interferon α and
ribavirin is the first-line treatment of this condition. However, in case of severe or life-threatening manifestations, absence of a virological response, or autonomized
vasculitis,
immunotherapy (alone or in addition to the
antiviral regimen) is necessary.
Rituximab is to date the only
biologic with a sufficient level of evidence to support its use in this indication. Several studies have demonstrated that
rituximab is highly effective when cryoglobulinaemic
vasculitis is refractory to
antiviral regimen, that association of
rituximab with
antiviral regimen may induce a better and faster clinical remission, and, recently, that
rituximab is more efficient than traditional immunosuppressive treatments. Some issues with regard to the optimal dose of
rituximab or its use as maintenance treatment remain unsolved. Interestingly, in balance with this anti-inflammatory strategy, a recent pilot study reported the significant expansion of circulating regulatory T lymphocytes with concomitant clinical improvement in patients with refractory HCV-induced cryoglobulinaemic
vasculitis using low dose of subcutaneous
interleukin-2. This paper provides an updated overview on the place of
immunotherapy, especially biologics, in the management of HCV-induced cryoglobulinaemic
vasculitis.