Etiologic treatment of hepatitis C virus-associated mixed cryoglobulinemia.

The treatment of mixed cryoglobulinemia (MC) includes several drugs--steroids, cyclosporins, colchicine, plasmapheresis--but given the documented association between MC and hepatitis C virus (HCV), the treatment of choice seems to be antiviral therapy. Several authors have reported the efficacy of interferon (IFN) alpha in the inhibition of HCV replication and reduction of cryoglobulin levels. The therapy with IFN as monotherapy in MC shows a complete response rate in only 10 -12% of cases. Complete response to therapy using a combination of IFN plus ribavirin varies in different studies from 18% to 64% of cases. There are only two studies on the treatment of MC with peginterferon plus ribavirin. Both studies, given the high number of complete responders, reinforce the idea that peginterferon plus ribavirin is, at present, the best available treatment for cryoglobulinemic syndrome. The results obtained with peginterferon combined therapy are superior to standard interferon plus ribavirin in treatment-naive patients. In fact, a sustained virological response was observed in 44% of patients; the same results were obtained for clinical (purpura and arthralgia disappearance) and biochemical (aminotransaminases normalization) responses. New drug combinations, like peginterferons plus anti-CD20 antibodies, should be considered for treatment of MC in the future.