Rituximab in Cryoglobulinemic Vasculitis: First- or Second-Line Therapy?
Rituximab is a monoclonal chimeric anti-CD20 antibody selectively targeting B cells. It has been shown to induce remission in HCV-associated cryoglobulinemic vasculitis as a first- or second-line treatment option. While rituximab induces a complete clinical response in 60–70% of patients with HCV-associated cryoglobulinemic vasculitis, viremia persists or even increases. Moreover, 30% of the patients are subject to relapses during peripheral blood B-cell recovery. The combination of rituximab and PEG-IFN-α plus ribavirin is aimed at providing the anti-proliferative impact and anti-viral potencies of both treatment approaches, with subsequent improvement of outcome. Rituximab and PEG-IFN-α plus ribavirin induce remission in severe and refractory HCV-associated cryoglobulinemic vasculitis. Based on the currently available evidence, combined treatment with rituximab and PEG-IFN-α plus ribavirin should be considered as the first-line treatment in patients with active disease resistant to anti-viral therapy and in those with severe manifestations and activity of cryoglobulinemic vasculitis. The inclusion of such patients in trials for further assessment and evaluation is highly desirable.
KeywordsSustained Virological Response Mixed Cryoglobulinemia Complete Clinical Response Cryoglobulinemic Vasculitis Moderate Disease Severity