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• W4232310852 abstract "We agree with Bruchfeld et al. that antiviral response to peg-interferon plus ribavirin is not effective in anti-HCV positive cryoglobulinemic patients as in patients without cryoglobulinemia, because they are usually older and their liver disease is more advanced [[1]Mazzaro C. Zorat F. Caizzi M. Donada C. Di Gennaro G. Dal Maso L. et al.Treatment with peg-interferon alpha-2b and ribavirin of hepatitis C virus associated mixed cryoglobulinemia: a pilot study.J Hepatol. 2005; 42: 632-638Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar].Peg-interferon alpha-2b monotherapy at a dosage of 1.0 μg/(kg/week) is the likely explanation for both the low response and the high relapse rates observed in our patients. When the study was started, tolerability and safety of the drug in patients affected by mixed cryoglobulinemia was unknown, therefore, we choose to treat with a low dosage [[1]Mazzaro C. Zorat F. Caizzi M. Donada C. Di Gennaro G. Dal Maso L. et al.Treatment with peg-interferon alpha-2b and ribavirin of hepatitis C virus associated mixed cryoglobulinemia: a pilot study.J Hepatol. 2005; 42: 632-638Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar]. Based on our results, this schedule could be recommended only in patients carrying genotype 2 or 3, who showed sustained virological response rates comparable to non-cryoglobulinemic patients, whereas it seems unsatisfactory for genotype 1 infections.Our patient suffering from membrano-proliferative glomerulonephritis showed only a transient response to therapy based on reduction of the proteinuria and micro-haematuria and a regression of vasculitic manifestation. Unfortunately, he relapsed after 2 months from the end of the therapy and serum HCV–RNA remained positive [[1]Mazzaro C. Zorat F. Caizzi M. Donada C. Di Gennaro G. Dal Maso L. et al.Treatment with peg-interferon alpha-2b and ribavirin of hepatitis C virus associated mixed cryoglobulinemia: a pilot study.J Hepatol. 2005; 42: 632-638Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar]. This observation is in accordance with our previous findings indicating that patients affected by cryoglobulinemia-related nephropathy are more difficult to treat.We are presently treating new cases of cryoglobulinemia-related nephropathy using anti-CD 20 monoclonal antibody [[2]Zaja F. De Vita S. Mazzaro C. Sacco S. Damiani D. De Marchi G. et al.Efficacy and safety of Rituximab in type II mixed cryoglobulinemia.Blood. 2003; 101: 3827-3834Crossref PubMed Scopus (450) Google Scholar]. At the end of the treatment, decrease or loss of cryocrit and decrease of rheumatoid factor (RF) was observed in patients with complete response without concurrent increase of complement levels [1Mazzaro C. Zorat F. Caizzi M. Donada C. Di Gennaro G. Dal Maso L. et al.Treatment with peg-interferon alpha-2b and ribavirin of hepatitis C virus associated mixed cryoglobulinemia: a pilot study.J Hepatol. 2005; 42: 632-638Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar, 3Mazzaro C. Zorat F. Comar C. Nascimben F. Bianchini D. Baracetti S. et al.Interferon plus ribavirin in patients affected by hepatitis C virus positive cryoglobulinemia resistant to previous interferon treatments.J Rheumatol. 2003; 30: 1775-1781PubMed Google Scholar]. We agree with Bruchfeld et al. that antiviral response to peg-interferon plus ribavirin is not effective in anti-HCV positive cryoglobulinemic patients as in patients without cryoglobulinemia, because they are usually older and their liver disease is more advanced [[1]Mazzaro C. Zorat F. Caizzi M. Donada C. Di Gennaro G. Dal Maso L. et al.Treatment with peg-interferon alpha-2b and ribavirin of hepatitis C virus associated mixed cryoglobulinemia: a pilot study.J Hepatol. 2005; 42: 632-638Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar]. Peg-interferon alpha-2b monotherapy at a dosage of 1.0 μg/(kg/week) is the likely explanation for both the low response and the high relapse rates observed in our patients. When the study was started, tolerability and safety of the drug in patients affected by mixed cryoglobulinemia was unknown, therefore, we choose to treat with a low dosage [[1]Mazzaro C. Zorat F. Caizzi M. Donada C. Di Gennaro G. Dal Maso L. et al.Treatment with peg-interferon alpha-2b and ribavirin of hepatitis C virus associated mixed cryoglobulinemia: a pilot study.J Hepatol. 2005; 42: 632-638Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar]. Based on our results, this schedule could be recommended only in patients carrying genotype 2 or 3, who showed sustained virological response rates comparable to non-cryoglobulinemic patients, whereas it seems unsatisfactory for genotype 1 infections. Our patient suffering from membrano-proliferative glomerulonephritis showed only a transient response to therapy based on reduction of the proteinuria and micro-haematuria and a regression of vasculitic manifestation. Unfortunately, he relapsed after 2 months from the end of the therapy and serum HCV–RNA remained positive [[1]Mazzaro C. Zorat F. Caizzi M. Donada C. Di Gennaro G. Dal Maso L. et al.Treatment with peg-interferon alpha-2b and ribavirin of hepatitis C virus associated mixed cryoglobulinemia: a pilot study.J Hepatol. 2005; 42: 632-638Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar]. This observation is in accordance with our previous findings indicating that patients affected by cryoglobulinemia-related nephropathy are more difficult to treat. We are presently treating new cases of cryoglobulinemia-related nephropathy using anti-CD 20 monoclonal antibody [[2]Zaja F. De Vita S. Mazzaro C. Sacco S. Damiani D. De Marchi G. et al.Efficacy and safety of Rituximab in type II mixed cryoglobulinemia.Blood. 2003; 101: 3827-3834Crossref PubMed Scopus (450) Google Scholar]. At the end of the treatment, decrease or loss of cryocrit and decrease of rheumatoid factor (RF) was observed in patients with complete response without concurrent increase of complement levels [1Mazzaro C. Zorat F. Caizzi M. Donada C. Di Gennaro G. Dal Maso L. et al.Treatment with peg-interferon alpha-2b and ribavirin of hepatitis C virus associated mixed cryoglobulinemia: a pilot study.J Hepatol. 2005; 42: 632-638Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar, 3Mazzaro C. Zorat F. Comar C. Nascimben F. Bianchini D. Baracetti S. et al.Interferon plus ribavirin in patients affected by hepatitis C virus positive cryoglobulinemia resistant to previous interferon treatments.J Rheumatol. 2003; 30: 1775-1781PubMed Google Scholar]." @default.
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