Prognosis of essential mixed cryoglobulinemia and connective tissue disease-related cryoglobulinemia after rituximab-induced remission

Poggi, C; Hachulla, E; Karras, A; Briantais, A; Ravaiau, C; Gobert, P; Deroux, A; Nicolas, S; Belfeki, N; François, H; Groh, M; London, J; Campagne, J; Allain, JS; Dernis, E; Durel, CA; Le Gallou, T; Curie, A; Kerschen, P; Gensous, N; Reboux, AH; Béhal, H; Terrier, B; Quéméneur, T

doi:10.1093/rheumatology/keaf324

Vasculitis & polymyalgia rheumatica

Prognosis of essential mixed cryoglobulinemia and connective tissue disease-related cryoglobulinemia after rituximab-induced remission

Rheumatology (Oxford)Published 10 Jun 2025Retrospective cohort study

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Authors' conclusion

In patients with EM and CTD-related CryoVas who received RTX as induction therapy, relapses were frequent and associated with purpura and a previous flare but were reduced with maintenance therapy.

Study context

Population: Patients with essential or connective tissue disease (CTD)-related mixed cryoglobulinemia vasculitis (CryoVas) in remission after rituximab (RTX)-based therapymedian follow-up 58 months (IQR, 33–88)
Participants: 63 patients

Outcome: Relapse (prognosis)

Main finding

As reported in the abstract

Relapse rates after the initial flare

Relapse rate at 1 year

23%

Relapse rate at 2 years

42%

Relapse rate at 5 years

71%

Observational data: associations, not effects.

Further findings

Factors associated with relapse, univariate analysis

	← Lower risk ←→ Higher risk →	HR (95% CI)	P value
Purpura	0.10.31310	2.2 (1.1–4.4)	P = 0.02
Previous flare of CryoVas	0.10.31310	1.9 (1.0–3.7)	P = 0.04
Maintenance therapy (early relapse)	0.10.31310	0.3 (0.1–0.9)	P = 0.03
Maintenance therapy (late relapse)	0.10.31310	2.0 (0.7–5.7)	P = 0.21
	0.10.31310Hazard ratio (log scale)

Outcome	← Lower risk with at least one of purpura or previous flare ←→ Higher risk with at least one of purpura or previous flare →	HR (95% CI)	P value
Factors associated with relapse, multivariable analysisAt least one of purpura or previous flarevs Neither purpura nor previous flare	0.10.31310	3.6 (1.6–8.2)	P = 0.002
	0.10.31310Hazard ratio (log scale)

Factors associated with relapse, multivariable analysis

	← Lower risk ←→ Higher risk →	HR (95% CI)	P value
Maintenance regimen (early relapse)	0.10.31310	0.3 (0.1–0.9)	P = 0.03
	0.10.31310Hazard ratio (log scale)

Original publication

Prognosis of essential mixed cryoglobulinemia and connective tissue disease-related cryoglobulinemia after rituximab-induced remission. Rheumatology (Oxford). Published 10 June 2025. doi:10.1093/rheumatology/keaf324

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