Rituximab plus Peg-interferon-alpha/ribavirin compared with Peg-interferon-alpha/ribavirin in hepatitis C-related mixed cryoglobulinemia.

Abstract

Treatment of hepatitis C (HCV)-mixed cryoglobulinemia (MC) may target either the viral trigger (HCV) or the downstream B-cell clonal expansion. Prospective cohort study of 38 HCV-MC patients who received a combination of rituximab (375 mg/m(2)) once a week for 1 month followed by Peg-interferon-alpha (Peg-IFN-alpha; 2a, 180 microg or 2b, 1.5 microg/kg) weekly plus ribavirin (600-1200 mg) daily for 48 weeks were compared with 55 HCV-MC patients treated by Peg-IFN-alpha/ribavirin with the same modalities. In the whole population of HCV-MC patients (n = 93), a complete clinical response was achieved in 73.1% (68 of 93), cryoglobulin clearance in 52.7% (49 of 93), and a sustained virologic response in 59.1% (55 of 93). Compared with Peg-IFN-alpha/ribavirin, rituximab plus Peg-IFN-alpha/ribavirin-treated patients had a shorter time to clinical remission (5.4 +/- 4 vs 8.4 +/- 4.7 months, P = .004), better renal response rates (80.9% vs 40% of complete response, P = .040), and higher rates of cryoglobulin clearance (68.4% vs 43.6%, P = .001) and clonal VH1-69(+) B-cell suppression (P < .01). Treatment was well tolerated with 11% of discontinuation resulting from antiviral therapy and no worsening of HCV RNA under rituximab. Our findings indicate that rituximab combined with Peg-IFN-alpha/ribavirin is well tolerated and more effective than Peg-IFN-alpha/ribavirin in HCV-MC.

• Authors: David Saadoun, Mathieu Resche Rigon, Damien Sene, Benjamin Terrier, Alexandre Karras, Laurent Perard, Yoland Schoindre, Brigitte Coppéré, François Blanc, Lucile Musset, Jean-Charles Piette, Michele Rosenzwajg, Patrice Cacoub
• Journal: Blood (Blood) Vol. 116 Issue 3 Pg. 326-34; quiz 504-5 (Jul 22 2010) ISSN: 1528-0020 [Electronic] United States
• PMID: 20439619 (Publication Type: Clinical Trial, Comparative Study, Journal Article)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Murine-Derived
• Antiviral Agents
• Interferon alpha-2
• Interferon-alpha
• RNA, Viral
• Recombinant Proteins
• Polyethylene Glycols
• Ribavirin
• Rituximab
• peginterferon alfa-2b
• peginterferon alfa-2a

Topics

• Aged
• Antibodies, Monoclonal (administration & dosage)
• Antibodies, Monoclonal, Murine-Derived
• Antiviral Agents (administration & dosage)
• Cohort Studies
• Cryoglobulinemia (drug therapy, etiology, immunology)
• Drug Therapy, Combination
• Female
• Hepatitis C, Chronic (complications, drug therapy, virology)
• Humans
• Interferon alpha-2
• Interferon-alpha (administration & dosage)
• Male
• Middle Aged
• Polyethylene Glycols (administration & dosage)
• Prospective Studies
• RNA, Viral (blood)
• Recombinant Proteins
• Remission Induction
• Ribavirin (administration & dosage)
• Rituximab
• Treatment Outcome