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Minerva Medica 2020 Jun 22

DOI: 10.23736/S0026-4806.20.06771-3

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Recent news in the treatment of hepatitis B virus-related cryogobulinemic vasculitis

Cesare MAZZARO 1 , Luigino DAL MASO 2, Marcella VISENTINI 3, Anna ERMACORA 4, Maurizio TONIZZO 4, Valter GATTEI 1, Pietro ANDREONE 5, 6

1 Clinical Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Pordenone, Italy; 2 Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Pordenone, Italy; 3 Department of Clinical Medicine, Laboratory affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy; 4 Department of Internal Medicine, Pordenone General Hospital, Pordenone, Italy; 5 SMECHIMAI Department, University of Modena e Reggio Emilia, Modena, Italy; 6 Internal and Metabolic Medicine, AOU di Modena, Modena, Italy


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Hepatitis B virus (HBV) is a hepatotropic virus that causes hepatitis, cirrhosis and hepatocellular carcinoma. Twenty percent of HBV patients may develop extra-hepatic manifestations, such as polyarthritis nodosa, glomerulonephritis, dermatitis, poly-arthralgia and arthritis, and aplastic anemia. The association of HBV and cryoglobulinemic vasculitis (CV) has been highlighted by several epidemiological investigations. CV can develop in 0.5- 4% of HBV infected patients. It has been demonstrated that suppression of HBV replication by nucleot(s)ide analogues (NAs) effectively induces clinical response in most patients with mild to moderate CV, but low responses are seen in severe CV. Based on this evidence, NAs therapy represents the first line therapeutic option in subjects with mild or moderate HBV related CV. Peg-interferon-Alfa can be an alternative treatment for HBV related CV, but the few studies published so far have shown no encouraging results. In patients with severe vasculitis and/or skin ulcers, peripheral neuropathy and glomerulonephritis treatment with rituximab (RTX) and NAs should be considered as a first line treatment. The long-term administration of low-medium glucocorticoid doses has been widely used in few studies to control clinical symptoms, but it should be used as a second option, when RTX is ineffective or not tolerated and in association with NAs. This review focuses on novel treatments for HBV related CV.


KEY WORDS: Cryoglobulinemia; Vasculitis; Hepatitis B virus; Entecavir; Tenofovir

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