摘要
混合型低血球蛋白血症(MC)是丙型肝炎病毒感染的最易发生的肝外表现。MC是一种自身免疫性或者B细胞淋巴增生性疾病紊乱,具有被称为冷球蛋白的循环免疫复合物的特征。MC患者表现出的症状是由于一种中小型血管(混合型冷球蛋白血症综合征,MCS)从5%至30%区间的系统性血管炎。MCS患者的一线治疗策略是病因治疗,在过去的15年,聚乙二醇化干扰素结合利巴韦林是治疗的标准。后来,直接抗病毒DAAs的出现明显优化了HCV感染的治疗,满足了使用无干扰素方案的条件。在此我们报道了一系列文献关于在治疗HCV相关的MC患者的抗病毒治疗作用及进展。此外我们也报道了8周治疗或者初步试验前瞻性研究的结果,试验包括17位于HCV相关的MC有或者没有MCS的患者在无干扰素治疗方案中用新一代的DAAs治疗。8周DAA给药后,所有的患者呈HCV 的RNA阴性。此外,35%患者低血球蛋白消失,并且总体来说观察到所有患者的冷球蛋白值降低(p<0.05)。此外,3个MCS-HCV患者(30%)结果显示为完整的临床应答者以及5名患者(50%)是部分临床应答。因此,无干扰素治疗的抗HCV治疗从病毒学和临床学角度来看是安全和有效的,因此也支撑了在缓解MC中根据HCV的重要性的根据。
关键词: 抗病毒治疗,直接抗病毒(DAA),有效性,HCV, 无干扰素,混合低血球蛋白血症,安全性
Current Drug Targets
Title:Virological and Clinical Response to Interferon-Free Regimens in Patients with HCV-Related Mixed Cryoglobulinemia: Preliminary Results of a Prospective Pilot Study
Volume: 18 Issue: 7
关键词: 抗病毒治疗,直接抗病毒(DAA),有效性,HCV, 无干扰素,混合低血球蛋白血症,安全性
摘要: Mixed Cryoglobulinemia (MC) is the most frequent extrahepatic manifestation of Hepatitis C virus (HCV) infection. MC is an autoimmune /B-cell lymphoproliferative disorder characterized by circulating immune-complexes, named cryoglobulins. MC patients exhibit symptoms due to a systemic vasculitis of small/medium size vessels (mixed cryoglobulinemia syndrome, MCS) in a percentage going from 5 to 30%. The first-line therapeutic option in MCS patients is the etiologic treatment and, in the past fifteen years, antiviral therapy with Pegylated-Interferon (Peg-IFN) plus Ribavirin (RBV) represented the standard of care. Lately, the arrival of direct acting antivirals (DAAs) significantly modified the cure of HCV infection, consenting the use of IFN-free regimens. Here we report a review of the literature about the role of antiviral treatment, following its evolution, in treating HCVrelated MC. Furthermore, we report the results, after 8 weeks of treatment, of a preliminary pilot prospective study, counting 17 patients with HCV-related MC with or without MCS, treated with new generation DAAs in IFN-free regimens. After 8 weeks of DAA administration, all the subjects were HCV RNA negative. Moreover, in 6/17 (35%) patients cryoglobulins disappeared and, on the whole, in all patients a decrease of the cryocrit values was observed (p<0.05). Furthermore, three MCS-HCV patients (30%) resulted to be complete clinical responders and 5 subjects (50%) partial clinical responders. Therefore, IFN-free anti-HCV treatment appears to be safe and effective in MC patients from virological and clinical points of view, thus supporting the importance of HCV eradication in leading MC remission.
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Virological and Clinical Response to Interferon-Free Regimens in Patients with HCV-Related Mixed Cryoglobulinemia: Preliminary Results of a Prospective Pilot Study, Current Drug Targets 2017; 18 (7) . https://dx.doi.org/10.2174/1389450117666160208145432
DOI https://dx.doi.org/10.2174/1389450117666160208145432 |
Print ISSN 1389-4501 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-5592 |
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