Therapeutic options in hepatitis C virus (HCV)-related
vasculitis may target the viral trigger using
antiviral therapy [pegylated
interferon plus
ribavirin (PEG-IFN/RBV)], and/or the downstream B-cell arm of autoimmunity with
rituximab (RTX). To date, no study has compared the efficacy of RTX combined with PEG-IFN/RBV on
biomarkers of
liver insufficiency in patients with severe
liver fibrosis. Twenty-eight untreated HCV-related
vasculitis patients with severe
liver fibrosis (Metavir F3-F4) were included: 14 patients received RTX plus PEG-IFN/RBV and 14 patients PEG-IFN/RBV. The main clinical and
biological data were recorded and compared at baseline, month 3 (M3), M12 and M24 of follow-up. Baseline epidemiological, clinical, virological and immunological features were similar between the groups. The virological response did not differ between cases and controls. The
alanine aminotransferase (ALT) level and HCV viral load did not increase in patients treated with RTX.
Serum albumin levels increased in patients treated with RTX at M3 and M6 (108% and 111% of baseline value; P = 0.06 and P = 0.13), whereas it was stable in patients treated without RTX. FibroTest values decreased from 0.70 at baseline to 0.59 at M3 (P = 0.5) and returned to 0.69 at M24 in the RTX-PEG-IFN/RBV group, whereas they were stable in the PEG-IFN/RBV group. RTX is safe in patients with severe HCV
liver fibrosis and
vasculitis. No beneficial effects of RTX were evidenced on
liver fibrosis progression, but we found interesting correlations with the
serum albumin level, FibroTest values and B-cell count.