Longterm efficacy of interferon-alpha for extrahepatic disease associated with hepatitis C virus infection. 11/2001
- J Rheumatol 2001 Nov;28(11):2466-73
Longterm efficacy of interferon-alpha for extrahepatic
disease associated with hepatitis C virus infection.
Naarendorp M, Kallemuchikkal U, Nuovo GJ, Gorevic PD.
Department of Pathology, Ohio State University School
of Medicine, Columbus, USA.
OBJECTIVE: To investigate longterm responsiveness to
interferon-alpha (lFN-alpha) of patients with
extrahepatic manifestations of hepatitis C virus (HCV)
in a nonendemic area. METHODS: We prospectively
evaluated 11 patients with extrahepatic manifestations
of HCV infection, including 10 with Type II
cryoglobulins, treated with IFN-alpha--9 had cutaneous
vasculitis, 6 arthralgias, 7 neuropathy, and 4
glomerulonephritis. Liver biopsies were performed on
all patients, although 6/11 had normal liver function
tests. All received 3 M units IFN-alpha tiw, with
total length of treatment ranging from 3 mo to 5 yrs.
Periodic assessments were made of clinical activity,
biochemical variables, cryoglobulin quantitation, and
HCV copy number. RESULTS: Three patients were
withdrawn because of toxicity. Three were
nonresponders at 6, 16, and 17 mo of therapy, based on
persistence of HCV RNA in blood, cryoprecipitates, and
peripheral blood mononuclear cells. One patient was a
partial responder at 3 yrs, with 2 major flares of
cutaneous vasculitis occurring on separate attempts to
withdraw IFN-alpha. Three patients (27.2%) were
complete responders based on resolution of symptoms
(purpura, neuropathy) and disappearance of
cryoprecipitates and HCV RNA, but only one
successfully tapered IFN-alpha after 3 yrs of
treatment, with sustained resolution at followup 15 mo
later. CONCLUSION: IFN-alpha is safely tolerated for
prolonged periods in patients with extrahepatic HCV
infection, and is particularly effective for treatment
of cutaneous vasculitis. Careful monitoring is needed
for evolution of liver pathology to cirrhosis, or for
progression of renal or neurologic disease.
PMID: 11708420 [PubMed - in process
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