Short-Term Clinical and Immunologic Outcomes Conditional on SVR12 in Hepatitis C Virus-Associated Cryoglobulinemic Vasculitis Treated With Direct-Acting Antivirals: A Systematic Review and Meta-Analysis.

Abstract

In contemporary clinical practice, direct-acting antiviral therapy (DAA) produces high rates of sustained virologic response (SVR) among patients with hepatitis C virus infection; however, short-term clinical and immunologic outcomes following viral eradication in HCV-associated cryoglobulinemic vasculitis remain incompletely characterized, particularly among patients who have already achieved SVR12. A systematic review and meta-analysis was performed to evaluate short-term outcomes conditional on achieving SVR12 among patients with symptomatic HCV-associated cryoglobulinemic vasculitis treated with interferon-free DAA therapy. EMBASE and PubMed were searched from inception through January 2026, and two reviewers independently screened studies and extracted data. Pooled proportions of complete clinical response, partial clinical response, and complete immunologic response at the time of SVR12 were calculated using random-effects models. Eighteen observational studies were included. Among patients who achieved SVR12, the pooled proportion of complete clinical response was 64.8% (95% CI: 49.6%-79.3%), while partial clinical response occurred in 23.8% (95% CI: 18.3%-30.4%). Complete immunologic response was observed in 43.9% of patients (95% CI: 36.6%-51.5%). Substantial heterogeneity was observed for clinical outcomes reflecting differences across observational cohorts, whereas heterogeneity was lower for immunologic response. In conclusion, among patients with HCV-associated cryoglobulinemic vasculitis who achieved SVR12 with DAA therapy, short-term clinical improvement was common, although complete immunologic normalization was less frequent. These findings provide clinically relevant prognostic information regarding early expectations following viral eradication, while highlighting that longer-term durability of response requires ongoing evaluation.