Plasma Exchange Effective in Treating Hepatitis C-Associated Cryoglobulinemia: Presented at AASLD
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By Maria Bishop

BOSTON, MA -- November 5, 2007 -- Plasma exchange (plasmapheresis) is an effective therapy for the short-term management of hepatitis C virus (HCV)-associated cryoglobulinemia, according to research presented here at the 58th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD).

Cryoglobulinemia is a symptom in 35% of chronic HCV infections, and is generally recognised by "Meltzer's triad" of palpable purpura (spontaneous bleeding into the skin that appears as a rash), joint pain, and muscle pain. Cryoglobulinemia is the presence of a high amount of heavy globulins (eg, Immunoglobulin M) in the bloodstream that thicken upon exposure to cold.

According to Jan C. Hofmann, MD, Staff Physician, Department of Medicine, Division of Immunotherapy, California Pacific Medical Center, San Francisco, California, United States, acute treatment is required for progressive, systemic cryoglobulinemia, which is further characterised by renal dysfunction, cutaneous vasculitis, peripheral neuropathy, or other organ involvement.

In a small, retrospective study, Dr. Hofmann and Robert Gish, MD, Medical Director, Liver Disease Management & Transplant Program, California Pacific Medical Center, examined the medical records of 21 patients diagnosed between January 2005 and May 2007 with moderate to severe HCV-associated cryoglobulinemia and referred to the California Pacific Medical Center for plasmapheresis treatment.

Nineteen of the patients (90%) received a course of inpatient plasma exchange every other day (mean number of treatments 8.4). The other two patients received outpatient plasma exchange 2 to 3 times per week.

Twenty patients (95%) experienced clinical improvement with plasmapheresis, the researchers noted.

Nine of 13 patients with nephrotic-range proteinuria experienced a significant decline in urinary protein and a mean decrease of 45% in serum creatinine. Three of 6 dialysis patients were able to stop dialysis.

Seventeen of 18 patients with elevated rheumatoid factor (RF) had a marked decrease in RF (12 of these normalised their levels). Twelve of thirteen patients with active vasculitic skin lesions demonstrated significant improvement. Six of 7 patients with peripheral neuropathy experienced a slight to moderate improvement in symptoms.

Of the inpatients, several were treated with additional concurrent therapies after plasmapheresis: 8 received low-dose oral or intravenous cyclophosphamide to prevent rebound of immune-complex production; 5 underwent rituximab weekly treatment (4 to 6 doses); 15 started weekly pegylated alfa interferon therapy for up to 4 weeks; and 12 also started daily oral ribavirin.

Some patients, Dr. Hofmann noted, may require maintenance plasmapheresis treatment for persistent, acute cryoglobulinemia.

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