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
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 February 18, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-of-cryoglobulinemic-vasculitis-with-sofosbuvir-in-four-combination-protocols/