Journal of autoimmunity · 2026
HCV-related cryoglobulinemic vasculitis (mixed cryoglobulinemia syndrome) in the era of direct-acting antivirals: A 10-year experience from Italian tertiary referral centers.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Ferri Clodoveo, Visentini Marcella, Vacchi Caterina, Lauletta Gianfranco, Naclerio Caterina, De Giorgi Irene, Caruso Teresita, Villa Annalisa, D'Ambrosi Matteo, D'Arcangelo Francesca, Marri Silvia, Fallhai Poupak, Antonelli Alessandro, Zignego Anna Linda, Giuggioli Dilia, Gragnani Laura, Casato Milvia
Аннотация
OBJECTIVE: To evaluate long-term clinico-serological response to direct-acting antivirals (DAAs) in patients with HCV-related cryoglobulinemic vasculitis (HCV-CV), and to compare the incidence of severe disease complications before/after antiviral therapy (AVT). The study also aimed to explore patterns of disease evolution following AVT.
METHODS: This retrospective multicenter study included 161 HCV-CV patients (mean age 63.9 ± 11.1 years; 64.6% females) treated with DAAs and achieving sustained virological response. The mean observation period was 8.2 ± 5.2 years, including pre-AVT (2.2 ± 5.5) and post-AVT (5.6 ± 2.7) phases. Complete response (CR) was defined as full resolution of baseline CV symptoms, partial response (PR) as ≥50% improvement, all others were non-responders (NR).
RESULTS: Post-AVT, significant reductions were observed in purpura (64% to 14%), fatigue (72% to 35%), arthralgias (55% to 26%), sicca syndrome (32% to 16%), skin ulcers (13% to 4%), and liver involvement (74% to 25%) (all p < 0.01), along with decreased cryocrit % (3.5 ± 4.6 to 0.5 ± 1.5, p < 0.0001) and increased C4 levels (9.6 ± 8.5 to 20.2 ± 11 mg/dl; p < 0.0001). CR was achieved in 74%, PR in 14%, NR in 12% of patients. Severe CV complications occurred more frequently pre-AVT than post-AVT (71% vs. 29%; p < 0.0001), particularly in NR patients (47% vs PR 26% and CR 12%; p = 0.0006), and those with persistent cryoglobulins (53% vs 12% without; p < 0.0001). Of note, NR patients showed mean higher cryocrit (p = 0.0046) and lower C4 (p = 0.025) levels evaluated within the last 12 months before DAAs.
CONCLUSION: DAAs significantly improved the clinical course of HCV-CV. Three post-treatment subsets can be identified: CR patients with minor residual symptoms, PR requiring careful monitoring, and NR group at high-risk for severe CV complications. Persistent serum cryoglobulins are predictors of long-term worse clinical course.
METHODS: This retrospective multicenter study included 161 HCV-CV patients (mean age 63.9 ± 11.1 years; 64.6% females) treated with DAAs and achieving sustained virological response. The mean observation period was 8.2 ± 5.2 years, including pre-AVT (2.2 ± 5.5) and post-AVT (5.6 ± 2.7) phases. Complete response (CR) was defined as full resolution of baseline CV symptoms, partial response (PR) as ≥50% improvement, all others were non-responders (NR).
RESULTS: Post-AVT, significant reductions were observed in purpura (64% to 14%), fatigue (72% to 35%), arthralgias (55% to 26%), sicca syndrome (32% to 16%), skin ulcers (13% to 4%), and liver involvement (74% to 25%) (all p < 0.01), along with decreased cryocrit % (3.5 ± 4.6 to 0.5 ± 1.5, p < 0.0001) and increased C4 levels (9.6 ± 8.5 to 20.2 ± 11 mg/dl; p < 0.0001). CR was achieved in 74%, PR in 14%, NR in 12% of patients. Severe CV complications occurred more frequently pre-AVT than post-AVT (71% vs. 29%; p < 0.0001), particularly in NR patients (47% vs PR 26% and CR 12%; p = 0.0006), and those with persistent cryoglobulins (53% vs 12% without; p < 0.0001). Of note, NR patients showed mean higher cryocrit (p = 0.0046) and lower C4 (p = 0.025) levels evaluated within the last 12 months before DAAs.
CONCLUSION: DAAs significantly improved the clinical course of HCV-CV. Three post-treatment subsets can be identified: CR patients with minor residual symptoms, PR requiring careful monitoring, and NR group at high-risk for severe CV complications. Persistent serum cryoglobulins are predictors of long-term worse clinical course.