Background: Mixed cryoglobulinemia (MC) vasculitis represents a complication of the B cell response to a variety of chronic inflammatory diseases. Recent reports describe the use of monoclonal antibodies directed to CD20 antigen (Rituximab), a transmembrane protein expressed on pre-B lymphocytes and mature lymphocytes. The goal of this article is to review published data in order to better analyze the efficacy and tolerance of Rituximab treatment in patients with MC vasculitis.
Methods and results: After systematic review of the literature and exclusion of review papers, 13 references reported on a total number of 57 cases of MC secondary to hepatitis C virus (HCV) infection (75.4%) or essential mixed cryoglobulinemia (24.6%). Previous treatments failed to control the main signs of vasculitis; these were either HCV (n=37) or immunomodulating treatments. Most patients (48/57) received four weekly consecutive IV infusions of 375 mg/m2 of Rituximab. The duration of follow-up after Rituximab therapy was 9.7 months. Rituximab infusions had great efficacy on the main vasculitis signs, with a clinical response in 80-93% patients. A relapse of MC was noted in 14/36 (39%) patients. A relatively small number of side effects were reported.
Conclusion: Rituximab therapy for patients with mixed cryoglobulinemia vasculitis, HCV-induced or essential, shows a great efficacy on the main vasculitis signs in the majority of reported patients. A relapse of cryoglobulinemia vasculitis was frequently noted. Randomised controlled trials with long term study are needed to conclude definitively on the benefit/risk ratio of Rituximab therapy in such patients.
- anti-CD20 (rituximab)
- cryoglobulinemia vasculitis
- hepatitis C virus