318. Long-term efficacy of direct-acting antivirals in patients with HCV-associated cryoglobulinemia
Creators: name: Sofiia Gavrisheva1
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background/ Objectives</strong>: Direct-acting antivirals (DAAs) have shown their efficacy in patients with HCV-associated cryoglobulinemic vasculitis after short-term follow-up. However, long-term outcomes after HCV eradication are not fully understood. <strong>Methods: </strong>Patients with HCV- associated cryoglobulinemic vasculitis (HCV-CV) or asymptomatic cryoglobulinemia (AC) treated with DAAs ± ribavirin were retrospectively evaluated. The activity of HCV-CV was assessed by using Birmingham Vasculitis Activity Score version 3 (BVAS.v3). Primary outcomes in all patients were sustained virologic (defined as undetectable HCV-RNA levels 12 weeks after treatment cessation) and immunological (defined as absence of circulating cryoglobulins, rheumatoid factor and normal C4 level) response. In patients with HCV-CV complete (defined by a BVAS.v3 score of 0) and partial (defined as BVAS.v3 score &lt; 50% of the baseline score) response were assessed. <strong>Results: </strong>A total of 29 patients [72.4% -females, median baseline age was 53 (48-59) years, 93.1% had cirrhosis, 65.5% had genotype 1b HCV] with HCV - associated cryoglobulinemia were enrolled in this study. Nine (31.1%) of them met the criteria for HCV-CV and 20 (68.9%) patients had asymptomatic cryoglobulinemia. The main manifestations of HCV-CV included skin purpura (89%), arthralgias or arthritis (56%), renal impairment (44%), sensory peripheral neuropathy (44%) and skin ulcers (11%). 3 patients had monoclonal gammopathy. The median duration of follow-up period was 26 (15-36) months after treatment cessation. During the follow-up period all patients achieved SVR12. Median BVAS.v3 score significantly decreased from 5 (at baseline) to 1 point (p=0.007) at the end of follow-up. Complete immunologic response and cryoglobulins elimination was achieved in 10 (34.5%) and 18 (62.1%) of patients, respectively. However, in 11 (37.9%) and 9 (31%) patients cryoglobulinemia and rheumatoid factor persisted, respectively, at the end of follow up. Median rheumatoid factor level decreased from 17.45 IU/ml at baseline to 12.9 IU/ml at the end of follow-up. Complete and partial clinical response were achieved by 3 (33.3%) and 4 (44.4%) patients with HCV-CV, respectively. Two patients (22.3%) were clinical non-responders due to persistence of severe arthralgias, peripheral neuropathy and renal impairment. The HCV-CV skin manifestations were improved in 6 (66.7%) patients with baseline features, joint involvement in 3 (60%) of patients, renal impairment in 3 (75%) of patients and sensory neuropathy only in 1 (25%) patient. Overall, BVAS.v3 score improved in all patients with HCV-CV. One patient had relapse of skin ulcers during follow-up. In this patient cryoglobulins and rheumatoid factor persisted. No patient died or developed severe HCV-CV during follow-up period. <strong>Conclusions: </strong>DAAs therapy of patients with HCV-CV and AC was associated with high rates of SVR, elimination of circulating cryoglobulins and clinical improvement in a long-term follow-up analysis. However, most patients did not achieve a complete clinical or immunological response during follow-up period. <strong>Disclosures: </strong>The authors declare no conflicts of interest.