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Long-Term Outcomes Favourable for Rituximab Monotherapy in Cyroglobulinemic Vasculitis

November 19 2014 8:38 AM ET via RheumReports RheumReports

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.


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About the Author

Dr. Lillian Barra
Dr. Lillian Barra

Lillian Barra is an Assistant Professor at Western University. Her research interests include autoimmune vascular disease and the role of autoantibodies in rheumatoid arthritis.

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