Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_45_библиотеки_им_акад_М_И_Перельмана

1999). However, cryoglobulinemic vasculitis following successful antiviral treatment persists in a small collective (Levine 2005). Data from a large prospective study in chronically HCV-infected patients with MC who have been treated with Peg-IFN α plus ribavirin conirmed the close relationship between virologic response and clinical-immunological response. Indeed, all patients with sustained virologic response also experienced a sustained clinical response, either complete or partial. In the majority of sustained virologic response patients all MCS symptoms persistently disappeared (36 patients, 57%); in only two (3%) did deinite MCS persist. All virologic non-responders were also clinical non-responders, in spite of a transient improvement in some cases (Gragnani 2015). The amount of the clinical beneit of HCV therapy seems to be inversely correlated with the time from diagnosis to initiation of antiviral therapy, which favors an early start of treatment (Mahale 2018). A therapeutic limitation seems to be the possible persistence of B-cell clones in a dormant state long ater HCV eradication has been established, as there is a risk of reactivation leading to recurrent cryoglobulinemia syndrome (Visentini 2019). In case of treatment failure of antiviral therapy and/or fulminant manifestations, contraindications or severe side efects, alternative therapeutic strategies such as cytostatic immunosuppressive therapy and/or plasmapheresis have been considered in the interferon era (Craxi 2008) (Figure 3, Table 4). Rituximab has been shown to be an efective and safe treatment option for MC even in advanced liver disease. Moreover, B cell depletion can lead to improvement ofcir rhotic syndrome by mechanisms that remain to be elucidated (Petrarca 2010).