The majority of cyroglobulinemic vasculitis occurs secondary to hepatitis C; however, some patients cannot tolerate antiviral treatment or or it is ineffective for vasculitic manifestations. Luca Quartuccio (abstract #2855) presented long-term findings of a RCT of rituximab monotherapy for severe cyroglobulinemic vasculitis.
All of the enrolled patients (n=30) had severe manifestations of cyroglobulinemic vasculitis secondary to hepatitis C. Half had failed antiviral therapy and 50% had not tolerated it. The mean follow-up time was 73 months. More than half (57%) of subjects required retreatment with rituximab with a mean time to relapse of 22 months. Of these, 2/3 responded and the other 1/3 failed. Mortality was high (20%), but not attributable to rituximab treatment.
Interestingly, 6 patients remained in remission after only 1 rituximab cycle and for the relapsers, all except 1 patient did not require more than 2 cycles throughout the follow-up period.
Rituximab appears to be a good option for hepatitis C cyroglobulinemic vasculitis; however, patients in this study were not exposed to newer, highly effective antivirals, which can eradicate infection in up to 90% of patients. Further studies are needed to investigate the efficacy of these antivirals in hepatitic C cyroglobulinemic vasculitis compared to rituximab.