Yes, There Are Treatments For Cryoglobulinemia!

There is no standard treatment protocol. Treatments must be worked out with your medical specialist and vary greatly depending on symptoms, severity, organ involvement and other factors.

  • Treatments vary widely depending on other active diseases in the body. Treatment for people with cryoglobulinemia that have an associated disease usually focused on the associated disease. For example; the treatments for Cryoglobulinemia, if someone has multiple myeloma and cryo will likely focus on the myeloma first.
  • The vast majority of people who have cryoglobulinemia have it due to Hepatitis C (HCV). For those patients with HCV and cryoglobulinemia, treatment is focused on managing the HCV first, in most cases.
  • For people with cryoglobulinemia who do NOT have HCV, the treatment path varies radically for person to person.
  • Some cryo patients achieve prolonged periods of remission through the use of medications. During these periods the signs or symptoms of the disease are absent.
  • In the case of Essential Mixed Cryoglobulinemia, remission periods may be obtain.
  • Deciding to take immune-suppressing drugs is a hard decision to be discussed with your doctor.
    • ed through the use of DMARDs, immune-suppressing drugs, monoclonal antibody therapy and/or a variety of chemotherapy drugs.
    • Plasmapheresis has also been used in conjunction with drugs to improve symptoms.

    How Do I Decide if I Need Immune Suppression?

    That said it comes down to risk management; a cost benefit analysis of disease versus side effects of medicines.

  • It is all about risk management. For a more serious situation, a bigger risk may be warranted in order to gain more effectiveness.
  • The doctor has to make this kind if decision… and so do you, the patient.
    • For example, using cyclophosphamide with prednisone to force remission in a case of cryo is not unusual. Once remission is established, one can transition to something like Imuran, methotrexate, or CellCept.
    • Often a patient might not tolerate one of the medications very well, forcing a change to another.
  • Some get along with Imuran very well, so it is a good choice and has less risk than staying on cyclophosphamide.
    • Also, Imuran is a reasonably safe drug to stay on if you have to take it long-term. So it really boils down to risk management vs effectiveness and having a list of possible options.
  • Plaquenil is not a heavy hitter like the above immunosuppressants are, but it is a lot safer and has fewer side effects, so if it works for you, it works…. and that is a good thing.
  • If you need to take the medication, you take it.

What are Disease Modifying Anti-Rheumatic Drugs?

Disease Modifying Anti-Rheumatic Drugs (DMARD’s)

  •  If you are being treated for cryo, chances are that you are on one of the drugs that I have listed here or are considering them as options with your doctor.
  • DMARDs are a class of drugs commonly used to treat a variety of autoimmune disorders.
  • Some were developed primarily for the treatment of cancer, malaria, or for preventing organ rejection in transplant patients.
  • DMARDs are sometimes referred to as “steroid-sparing” drugs because they often allow greater overall effectiveness at maintaining remission of autoimmune disorders when used in combination with low dose prednisone. In some cases, more than one DMARD may be used in combination.
  • Each DMARD is a bit different from the others, effectiveness varies from one condition to the next and the side effect profiles are also highly variable.
  • Some DMARDs have a greater risk of potentially dangerous conditions and the patient must be monitored continuously for their safety.

What are kinds of DMARDS

Below, are listed some common DMARDs in order of their basic action on the body, this list is not complete and you will want to search the internet and find further information on your favorite DMARD with regard to risks, safety, drug interactions, and side effects. The following drugs include the antimalarial agents, are frequently slow to take effect and some have significant long-term side effects.

  1. gold (rarely used) Sometimes effective for rheumatoid arthritis). This treatment has been around since the Victorian era! It is not well understood and tends to cause increasingly severe side effects over time.
  2. hydrochloroquine (Plaquenil) An anti-malaral agent. Often used in combination with steroids, commonly used to treat Lupus.
  3. methotrexate commonly used for a variety of autoimmune disorders and may be used in combination with other DMARDs
  4. sulfasalazine Often used to treat Chron’s disease, may be used with other DMARDs.
  5. cyclosporine Developed to prevent organ rejection in transplant patients. This drug may have serious long-term safety issues. It is sometimes used in cases where nothing else works.

Immunosuppressants

The following drugs are the immunosuppressants. They can be slow to take effect and carry a risk from infection due to suppression of the immune system. Side effects vary, some are not so bad, but others have *significant* risks and side effects and the patient must be closely monitored.

  1. cyclophosphamide (Cytoxan) Commonly used in oral and IV form, frequently used in combination with prednisone to force remission. Has a relatively big risk and side effect profile. This is generally viewed as a serious “big gun” that suppresses the immune system deeply.
  2. Imuran (Azathioprine) Commonly used to maintain remission after remission is established. Commonly used with low dose prednisone.Less risk and fewer side effects than Cytoxan. Slower to take effect than Cytoxan. Does not suppress the immune system as deeply as Cytoxan.Imuran carries a small, but real risk of causing the immune system to die off rather quickly, so your blood counts must be monitored carefully.  Low white blood cells and low producing neutrophils are a risk.
  3. leflunomide Sometimes used alone, but may be used with another DMARD, or a biological agent.
  4. mycophenolate mofetil (CellCept) Originally developed to prevent organ rejection in transplant patients. Often used in combination with other DMARD’s, and more recently used in combination with biological DMARD.

  1. Biological Agents (so-called bDMARDs)
    1. Tumor Necrotic Factor (TNF) Inhibitors
    2. including etanercept, adalimumab, infliximab, certolizumab pegol, and golimumab,
  2. Specific Biological Agents with specific targets (also called Monoclonal Antibody Therapy = MAB)
    1. These drugs are basically designer antibodies that have very specific targets.
    2. For example: rituximab (rituxin) targets B cells specifically.
    3. including anakinra, abatacept , rituximab, tocilizumab, and tofacitinib. These medications are often combined with methotrexate or other DMARDs to improve efficacy.

What Drugs Treat Cryoglobulinemia?

Disease Modifying Anti-Rheumatic Drugs (DMARD’s)

  • If you are being treated for cryo, chances are that you are on one of the drugs that listed here.
  • DMARDs are a class of drugs commonly used to treat a variety of autoimmune disorders. Some were developed primarily for the treatment of cancer, malaria, or for preventing organ rejection in transplant patients.
  • DMARDs are sometimes referred to as “steroid sparing” drugs because they often allow greater overall effectiveness at maintaining remission of autoimmune disorders when used in combination with low dose prednisone. In some cases more than one DMARD may be used in combination.
  • Each DMARD is a bit different from the others, effectiveness varies from one condition to the next and the side effect profiles are also highly variable. Some DMARDs have a greater risk of potentially dangerous conditions and the patient must be monitored for the sake of safety.

What Types of Drugs?

  • Listed below are some common DMARDs in order of their basic action on the body, this list is not complete and you probably want to search the internet and find further information on your favorite DMARD with regard to risks, safety, drug interactions, and side effects.
  • Immunosuppresants. They can be slow to take effect and carry a risk from infection due to suppression of the immune system. Side effects vary, some are not so bad, but others have *significant* risks and side effects and the patient must be closely monitored.
    • cyclophosphamide (cytoxan) Commonly used in oral and IV form, frequently used in combination with prednisone to force remission. Has a relatively big risk and side effect profile. This is generally viewed as a serious “big gun” that suppresses the immune system deeply.
    • Imuran (Azathioprine) Commonly used to maintain remission after remission is established. Commonly used with low dose prednisone. Less risk and fewer side effects than cytoxan. Slower to take effect than cytoxan. Does not suppress the immune system as deeply as cytoxan.
      Imuran carries a small, but real risk of causing the immune system to die off rather quickly, so your blood counts must be monitored carefully.
    • leflunomide Sometimes used alone, but may be used with another DMARD, or a biological agent.
    • mycophenolate-mofetil (cellcept) Originally developed to prevent organ rejection in transplant patients. Often used in combination with other DMARD’s, and more recently used in combination with biological DMARDs.
  • Biological Agents (so-called bDMARDs)
    • Tumor Necrotic Factor (TNF) Inhibitors
      including etanercept, adalimumab, infliximab, certolizumab pegol, and golimumab,
  • Monoclonal Antibody Therapies:  These are also Biological Agents but with different targets
    • These drugs are basically designer antibodies that have very specific targets.
      • For example: rituximab (rituxin) targets B cells specifically.
    • Rituximab is quickly becoming a standard ‘go-to’ treatment for severe chronic cryoglobulinemia.
    • including anakinra, abatacept , rituximab, tocilizumab, and tofacitinib. These medications are often combined with methotrexate or other DMARDs to improve efficacy.
  • Antimalarial Agents. The following drugs include the antimalarial agents, are frequently slow to take effect and some have significant long-term side effects.
    • hydrochloroquine (Plaquenil) An anti-malaral agent. Often used in combination with steroids, commonly used to treat Lupus.
    • methotrexate commonly used for a variety of autoimmune disorders and may be used in cmbination with other DMARDs
    • sulfasalazine Often used to treat Chron’s disease, may be used with other DMARDs.
    • cyclosporine Developed to prevent organ rejection in transplant patients. This drug may have serious long term safety issues. It is sometimes used in cases where nothing else works.

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