ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2977

Treatment of Cryoglobulinemic Vasculitis with Sofosbuvir in Four Combination Protocols

Mohamed Tharwat Hegazy1, Mohamed A Hussein1, Luca Quartuccio2, Mary Fawzy1, Naguib Zoheir3, Mona I. Ellawindi4, Milena Bond2, Cesare Mazzaro5, Ahmed El Ray6, Maissa El Said El Raziky7,8, Magdy El Serafy9, Wahid Doss9, Patrice Cacoub10, Loïc Guillevin11, Salvatore De Vita2, Sherif El Khamisy12 and Gaafar Ragab1, 1Internal Medicine, Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt, Cairo, Egypt, 2Rheumatology Clinic, DSMB, University of Udine, Udine, Italy, Udine, Italy, 3Clinical and Chemical Pathology Department, Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt, Cairo, Egypt, 4Community Medicine, Community Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt, Cairo, Egypt, 5Internal Medicine, Pordenone Hospital, Italy, pordenone, Italy, 6Theodor Bilharz Research Institute, Cairo, Egypt, Cairo, Egypt, 7Fatimid Cairo hospital, Cairo, Egypt, Cairo, Egypt, 8Tropical Medicine, Tropical Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt, cairo, Egypt, 9Tropical Medicine, Tropical Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt, Cairo, Egypt, 10Internal Medicine Department, University Hospital “Pitié-Salpêtrière”, “Pierre et Marie Curie Paris VI” University, Paris, France, 11Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France, 12Zewail city of Science and Technology, Egypt, Giza, Egypt

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: , ,

Session Information

Date: Tuesday, November 15, 2016

Title: Vasculitis - Poster III: Rarer Vasculitides

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Cryoglobulinemic Vasculitis (CV) is a systemic vasculitis affecting small and medium-sized vessels. Following emergence of direct acting antiviral drugs, which paved the way to avoid both the side effects of immunosuppressive treatments; and also Interferon. The aim of our study was to assess the effect of Sofosbuvir in the treatment of HCV- CV manifestations

Methods: This is a multicenter interventional treatment trial, including 26 Egyptian patients and 9 Italian patients with CV, diagnosed according to the Classification criteria of Cryoglobulinemic Vasculitis, which were validated in 2014. Patients were treated with Sofosbuvir following four treatment protocols: 1- Sofosbuvir + Ribavirin for 6 months, 2- Sofosbuvir + Ribavirin + Interferon for 3 months, 3- Sofosbuvir + Daclatasvir for 3 months, and 4- Sofosbuvir + Simeprevir for 3 months. Clinical assessment (according to the Classification criteria of CV), cryocrit %, C4 serum level and serum level of rheumatoid factor (RF), were recorded soon before and at the end of the treatment. Response was assessed as complete, partial or absent (no response). Analytical procedures used were Pearson Chi-Square and Wilcoxon tests as indicated.

Results: 35 patients (24 females, mean age 56 ± 11 y) were enrolled in the study. Sixteen patients showed liver cirrhosis. All patients were Child- Pugh A stage. 13,8,5,9 patients were treated by first, second, third, fourth protocol, respectively. All patients showed a sustained viral response (SVR). All patients had purpura and all of them responded to treatment. 35 patients had Fatigue and 24 patients had fibromyalgia, 34, 22 patients responded respectively. 26 patients had arthralgia and 23 patients had non erosive arthritis, 22, 20 patients responded respectively. 13 patients had Raynaudˈs phenomenon and 2 patients had fibromyalgia, 12, 2 patients responded respectively after treatment. 25 patients had Peripheral poly neuropathy with total response after treatment in 21 patients. One of our patients had leg ulcer and mono- neuritis multiplex with complete response and completely healed ulcer after treatment. Nephritis was diagnosed in two patients, one of them had proteinuria and renal impairment and another one had proteinuria only, with total improvement of both by antiviral therapy alone. Serum level of Cryocrit (P value < 0.0001), RF (P value= 0.004), C4 (P value= 0.003), significantly decreased after treatment.

Conclusion: Antiviral combination therapy including Sofosbuvir appears very effective in the treatment of the most frequent CV manifestations. Since laboratory signs of CV improved but did not disappear, long-term clinical and biological effects of SVR by Sofosbuvir should be studied

Disclosure: M. T. Hegazy, None; M. A. Hussein, None; L. Quartuccio, None; M. Fawzy, None; N. Zoheir, None; M. I. Ellawindi, None; M. Bond, None; C. Mazzaro, None; A. El Ray, None; M. E. S. El Raziky, None; M. El Serafy, None; W. Doss, None; P. Cacoub, None; L. Guillevin, None; S. De Vita, None; S. El Khamisy, None; G. Ragab, None.

To cite this abstract in AMA style:

Hegazy MT, Hussein MA, Quartuccio L, Fawzy M, Zoheir N, Ellawindi MI, Bond M, Mazzaro C, El Ray A, El Raziky MES, El Serafy M, Doss W, Cacoub P, Guillevin L, De Vita S, El Khamisy S, Ragab G. Treatment of Cryoglobulinemic Vasculitis with Sofosbuvir in Four Combination Protocols [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/treatment-of-cryoglobulinemic-vasculitis-with-sofosbuvir-in-four-combination-protocols/. Accessed .

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-of-cryoglobulinemic-vasculitis-with-sofosbuvir-in-four-combination-protocols/