Session Type: Poster Session (Monday)
Session Time: 9:00AM-11:00AM
Previously chronic hepatitis C virus (HCV) infection was accountable for 80-90% of cases of mixed cryoglobulinemia (MC). The advent of direct-acting antivirals (DAA) has dramatically changed the management of chronic HCV infection. However, since their approval in 2011, data are very scarce on the prevalence of HCV-related MC. We aimed to study the main etiologies, clinical manifestations and immunological parameters of MC in the era of DAA agents.
Observational longitudinal cohort study that included 679 patients with MC at the Pitié-Salpêtrière Universitary Hospital, Paris, France, between 2011 and 2018. Demographic information (age at diagnosis, gender, year of diagnosis, etiology of MC) and laboratory data were recorded. Patients included were divided into two categories: HCV-related MC and non-HCV-related MC.
Results: The mean age of the patients was 55.5 (15.8) years, 54.5% were female, and 20.5% had vasculitis. Presence of vasculitis was not statistically different between HCV-related and non-HCV-related MC cases. Main clinical manifestations included skin involvement in 54.7%, neurological involvement in 49.6%, renal involvement in 21.6% and arthritis in 10.1% of patients. HCV-related MC cases had higher cryoglobulin levels (378 vs 369 mg/L, p< 0.001) and lower serum levels of complement C4 (0.16 vs 0.18, p< 0.001), whereas RF activity was higher in non-HCV-related cases (280 vs 261 UI/Lm p< 0.001).
Over the period of 2011 and 2018 chronic HCV infection accounted for 56% of cases of MC. The remaining causes of MC were autoimmune diseases (23%), hematological and neoplastic conditions (6%), infectious diseases other than chronic HCV infection (5%), whereas 10% of MC cases were identified as essential. In 2016-2017, HCV-related cases dropped with non-HCV-related cases representing the leading cause of MC. Indeed, in 2018, non-HCV-related represented 66.7% of MC.
Conclusion: DAA have changed the landscape of MC with HCV no longer being its leading cause in our cohort. Due to the safety profile and cure rates of DAA regimens, with HCV elimination being high on the world health agenda, we speculate that the incidence of HCV-related MC will dramatically decrease in the upcoming years.
To cite this abstract in AMA style:Boleto G, Ghillani-Dalbin P, Musset L, Cacoub P, Saadoun D. Mixed Cryoglobulinaemia Since the Advent of New Direct-acting Antivirals for Hepatitis C Infection: Clinical Characteristics, Etiologies and Biological Features in 679 Patients [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/mixed-cryoglobulinaemia-since-the-advent-of-new-direct-acting-antivirals-for-hepatitis-c-infection-clinical-characteristics-etiologies-and-biological-features-in-679-patients/. Accessed April 13, 2021.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mixed-cryoglobulinaemia-since-the-advent-of-new-direct-acting-antivirals-for-hepatitis-c-infection-clinical-characteristics-etiologies-and-biological-features-in-679-patients/