Digestive Diseases and Sciences

, Volume 59, Issue 12, pp 3043–3052 | Cite as

Effectiveness of Telaprevir and Boceprevir Triple Therapy for Patients with Hepatitis C Virus Infection in a Large Integrated Care Setting

  • Jennifer C. Price
  • Rosemary C. Murphy
  • Valentina A. Shvachko
  • Mary Pat Pauly
  • M. Michele Manos
Original Article



In 2011, the FDA approved telaprevir (TVR) and boceprevir (BOC) for use with pegylated interferon and ribavirin to treat hepatitis C virus (HCV) genotype 1. We aimed to evaluate the real-world application, tolerability, and effectiveness of TVR- and BOC-based HCV treatment in a large integrated care setting.


We utilized Northern California Kaiser Permanente Medical Care Program (KPNC) electronic databases and medical records to study the experience of all KPNC patients who initiated TVR or BOC from June 2011 to March 2012.


Compared with the pool of 5,194 treatment-eligible patients, the 352 treatment initiators were more likely to be cirrhotic (24 vs. 10 %, p < 0.001) and treatment-experienced (44 vs. 22 %, p < 0.001). Among the treatment initiators, 211 received TVR and 141 BOC. Overall, 31 % discontinued treatment prematurely; 16 % of patients stopped treatment early because of side effects. One patient with cirrhosis died of sepsis during treatment. Premature discontinuation was highest among TVR-treated cirrhotic patients (58 %). Sustained virologic response (SVR) was achieved in 55 % overall and was similar comparing the TVR (56 %)- and BOC (53 %)-treated groups. The only independent predictors of treatment failure were cirrhosis at baseline [odds ratio (OR) for SVR 0.44, p = 0.004] and prior partial or null response (OR for SVR 0.57, p = 0.02).


In the initial application of TVR and BOC, patients with cirrhosis and prior treatment failure were prioritized for treatment. In this real-world experience, most patients successfully completed a full treatment course. However, side effect-related premature discontinuations were common, and SVR rates were lower than reported in clinical trials.


HCV DAA Antiviral therapy Telaprevir Boceprevir 







Hepatitis C virus


Northern California Kaiser Permanente Medical Care Program


Sustained virologic response


Odds ratio


Pegylated interferon




Human immunodeficiency virus


Hepatitis B virus


Viral Hepatitis Registry


Pharmacy information management system


Lower limit of detection


Lower limit of quantification


Response-guided therapy


Drug reaction with eosinophilia and systemic symptoms




Body mass index


Interquartile range


Veterans Affairs



We thank Dr. Suk Seo for helpful comments on the manuscript.

Conflict of interest

This work was supported by The Permanente Medical Group and was partially funded by Vertex Pharmaceuticals Incorporated. JP discloses serving as an advisor to Gilead and has ownership interest in Bristol-Myers Squibb, Johnson and Johnson, and Abbvie. MPP discloses clinical trial research support from Roche and Merck. MMM discloses research support from Merck, Gilead, and Vertex. RCM and VAS have no conflicts to declare.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Jennifer C. Price
    • 1
  • Rosemary C. Murphy
    • 2
  • Valentina A. Shvachko
    • 2
  • Mary Pat Pauly
    • 2
  • M. Michele Manos
    • 2
  1. 1.Division of Gastroenterology and Hepatology, Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Viral Hepatitis Registry, Division of ResearchKaiser Permanente Northern CaliforniaOaklandUSA

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