Skip to main content

Advertisement

Log in

Real World Experience in the Era of First Generation Protease Inhibitors in the Treatment of Hepatitis C

  • Hepatitis C: Therapeutics (MP Manns and T von Hahn, Section editors)
  • Published:
Current Hepatitis Reports Aims and scope Submit manuscript

Abstract

The treatment for hepatitis C has been revolutionized with the new era of protease inhibitors. Boceprevir (BOC) and telaprevir (TVR) are potent first generation direct acting antivirals which have demonstrated significantly improved response rates compared to interferon and ribavirin in phase III trials. However there are multiple real-life data sets showing increased adverse events and treatment discontinuations compared to clinical trials, especially in the cirrhotic patient. The advent of all oral, non-interferon regimens offers a promising treatment paradigm for hepatitis C infected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Jacobson IM, McHutchison JG, Dusheiko G, et al. Telaprevir for previously untreated chronic hepatitis C virus infection. N Engl J Med. 2011;364:2405–16.

    Article  PubMed  CAS  Google Scholar 

  2. Kwo PY, Lawitz EJ, McCone J, et al. Efficacy of boceprevir, an NS3 protease inhibitor, in combination with peginterferon alfa-2b and ribavirin in treatment-naïve patients with genotype 1 hepatitis C infection (SPRINT-1): an open label, randomized, multicentre phase 2 trial. Lancet. 2010;376:705–16.

    Article  PubMed  CAS  Google Scholar 

  3. Yee HS, Chang ME, Pocha C, et al. Update on the management and treatment of hepatitis C virus infection: recommendations from the department of veterans affairs Hepatitis C resource center program and the national Hepatitis C program office. Am J Gastroenterol. 2012;107:669–89.

    Article  PubMed  CAS  Google Scholar 

  4. McHutchison JG, Lawitz EJ, Shiffman ML, et al. Peginterferon alfa-2b or alfa-2a with ribavirin for treatment of hepatitis C infection. N Engl J Med. 2009;361:580–93.

    Article  PubMed  CAS  Google Scholar 

  5. Sherman KE, Flamm SL, Afdhal NH, et al. Response-guided telaprevir combination treatment for hepatitis C virus infection. N Engl J Med. 2011;365:1014–24.

    Article  PubMed  CAS  Google Scholar 

  6. Poordad F, McCone J, Bacon BR, et al. Boceprevir for untreated chronic HCV genotype 1 infection. N Engl J Med. 2011;364:1195–206.

    Article  PubMed  CAS  Google Scholar 

  7. Forestier N, Zeuzem S. Triple therapy with telaprevir: results in hepatitis C virus-genotype 1 infected relapsers and non-responders. Liver Int. 2012;32 Suppl 1:44–50.

    Article  PubMed  CAS  Google Scholar 

  8. Bacon B, Khalid O. Triple therapy with boceprevir for HCV genotype 1 infection: phase III results in relapsers and nonresponders. Liver Int. 2012;32 Suppl 1:51–3.

    Article  PubMed  CAS  Google Scholar 

  9. Bacon BR, Gordon SC, Lawitz E, et al. Boceprevir for previously untreated chronic HCV genotype 1 infection. N Engl J Med. 2011;364:1207–17.

    Article  PubMed  CAS  Google Scholar 

  10. Hezode C, Dorival C, Zoulim F, et al. Safety of telaprevir or boceprevir in combination with peginterferon alfa/ribavirin, in cirrhotic nonresponders. First results of the French early access program (ANRS CO20-CUPIC). J Hepatol. 2012;56(suppl):S4.

    Article  Google Scholar 

  11. Zeuzem S, Andreone P, Pol S, et al. Telaprevir for retreatment of HCV infection. N Engl J Med. 2011;364:2417–28.

    Article  PubMed  CAS  Google Scholar 

  12. Bichoupan K, Giannattasio ER, Martel-Laferriere V, et al. Side effects and adverse outcomes of telaprevir-based triple therapy in HCV-positive patients with and without advanced fibrosis: real life experience. Hepatology. 2012;56(suppl):1010A.

    Google Scholar 

  13. Forestier N, Moog G, Lutz T, et al. First real life data of triple therapy with telaprevir (TVR) and boceprevir (BOC) in combination with peg-interferon-alfa-2a (PEG) plus ribavirin (RBV) in patients infected with chronic hepatitis C (CHC), genotype 1 in a non-interventional study (PAN) in Germany. Hepatology. 2012;56(suppl):1038A.

    Google Scholar 

  14. Mousa O, Pham L, Egwin CI, et al. Virologic responses and safety of the current NS3/4A protease inhibitors (telaprevir and boceprevir) in HCV treatment-experienced patients. Hepatology. 2012;56(suppl):1039A.

    Google Scholar 

  15. Fontaine H, Hezode C, Dorival C, et al. SVR12 rates and safety of triple therapy including telaprevir or boceprevir in 221 cirrhotic non responders treated in the French Early Access Program (ANRS CO20-CUPIC). J Hepatol. 2013;58(suppl):S27.

    Article  Google Scholar 

  16. Mousa O, Pham L, Egwim CI, et al. Efficacy, tolerability, and discontinuations of the current direct acting agents in chronic hepatitis C patients with cirrhosis. Hepatology. 2012;56(suppl):1049A.

    Google Scholar 

  17. Hwang EW, Thomas I, Belperio PS, et al. Early virologic outcomes and hematologic safety of direct-acting antiviral (DAA)-bases therapy in US veterans with cirrhosis from hepatitis C virus (HCV) genotype 1. Hepatology. 2012;56(suppl):1001A.

    Google Scholar 

  18. Belperio PS, Hwang EW, Thomas IC, et al. Early virologic responses and hematologic safety of direct-acting antiviral therapies in veterans with chronic hepatitis C. Clin Gastroenterol Hepatol. 2013;11:1021–7.

    Article  PubMed  CAS  Google Scholar 

  19. Bichoupan K, Martel-Laferriere V, Ng M, et al. Real world effectiveness of telaprevir-based triple therapy: lower on-treatment virological responses than in RCTs. Hepatology. 2012;56(suppl):1044A.

    Google Scholar 

  20. Backus LI, Belperio PS, Thomas I, et al. Early virologic response and futility of direct acting antiviral (DAA)-based therapy in veterans with chronic hepatitis C. Hepatology. 2012;56(suppl):1036A.

    Google Scholar 

  21. Verna EC, Terry N, Lukose T, et al. High early response rates with protease inhibitor triple therapy in a multicenter cohort of HCV-infected patients awaiting liver transplantation. Hepatology. 2012;56(suppl):218A.

    Google Scholar 

  22. •• Fontaine H, Hezode C, Dorival C, et al. SVR12 rates and safety of triple therapy including telaprevir or boceprevir in 485 cirrhotic non responders treated in the French Early Access Program (ANRS CO20-CUPIC) [Abstract 60]. Presented at European Association for the Study of the Liver Conference. Amsterdam, Netherlands; April 24–28, 2013. This reference is the largest data set available in cirrhotic patients showing response rates and safety profile in those treated with triple-based therapy.

  23. Hezode C, Dorival C, Zoulim F, et al. Safety and efficacy of telaprevir or boceprevir in combination with peginterferon alfa/ribavirin in 497 cirrhotic non responders. Week 16 analysis of the French early access program (ANRS CO20-CUPIC) in real-life setting [Abstract 51]. Presented at American Association for the Study of Liver Disease Conference. Boston Massachusetts; November 9–13, 2012.

  24. Rutter K et al. Safety of triple therapy with telaprevir or boceprevir in hepatitis C patients with advanced liver diseases-predictive factors for sepsis [Abstract 65]. Presented at European Association for the Study of the Liver Conference. Amsterdam, Netherlands; April 24–28, 2013.

  25. Kapelusznik L et al. Boceprevir is associated with decline in renal function in a cohort of HCV-treated patients [Abstract 834]. Presented at European Association for the Study of the Liver Conference. Amsterdam, Netherlands; April 24–28, 2013.

  26. Mauss et al. Substantial renal impairment is not infrequent in HCV patients under triple therapy with telaprevir or boceprevir [Abstract 872]. Presented at European Association for the Study of the Liver Conference. Amsterdam, Netherlands; April 24–28, 2013.

  27. Maasoumy B, Port K, Markova AA, et al. Eligibility, safety and efficiency of triple therapy for chronic HCV genotype 1 infection in real world setting. Hepatology. 2012;56(suppl):1030A.

    Google Scholar 

  28. Chen EY, Sclair SN, Czul F, et al. Triple therapy for hepatitis C infection in the real world: practice trends following release of boceprevir and telaprevir. Hepatology. 2012;56(suppl):259A.

    Google Scholar 

  29. Chervenak AE, Aqel B, Byrne TJ, et al. Treatment of HCV in the DAA era: the impact of a multi-disciplinary team. Hepatology. 2012;56(suppl):228A.

    Google Scholar 

  30. Lawitz E, Zeuzem S, Nyberg LM, et al. Boceprevir (BOC) combined with peginterferon alfa-2b/ribavirin (P/RBV) in treatment-naïve chronic HCV genotype 1 patients with compensated cirrhosis: sustained virologic response (SVR) and safety subanalyses from then anemia management study. Hepatology. 2012;56(suppl):216A.

    Google Scholar 

  31. Lawitz E, Mangia A, Wyles D, et al. Sofosbuvir for previously untreated hepatitis C infection. N Engl J Med. 2013;368:1878–87.

    Article  PubMed  CAS  Google Scholar 

  32. Jacobson IM, Gordon SC, Kowdley KV, et al. Sofosbuvir for hepatitis C genotype 2 or 3 in patients without treatment options. N Engl J Med. 2013;368:1867–77.

    Article  PubMed  CAS  Google Scholar 

  33. Gane EJ, Stedman CA, Hyland RH, et al. All-oral sofosbuvir-based 12-week regimens for the treatment of chronic HCV infection: the electron study. J Hepatol. 2013;58(suppl):S6.

    Article  Google Scholar 

  34. • Sulkowski MS, Gardnier DF, Rodriguez-Torres M, et al. Sustained virologic response with daclatasvir plus sofosbuvir +/− ribavirin (RBV) in chronic HCV genotype (GT) 1-infected patients who previously failed telaprevir (TVR) or boceprevir (BOC). J Hepatol. 2013;58(suppl):570. This reference demonstrates that all oral, non-interferon therapy has been demonstrated to be safe and effective in treatment naïve and previous failure to telaprevir or boceprevir. These favorable responses have also been seen in cirrhotic patients..

    Article  Google Scholar 

  35. • Soriano V, Gane EJ, Angus PW, et al. Efficacy and safety of the interferon (IFN)-free combination of B 201335 + BI 207127 +/− ribavirin (RBV) in treatment-naïve patients with HCV genotype (GT) 1 infection and compensated liver cirrhosis: results from the SOUND-C2 study. Hepatology. 2012;56(suppl):234A. This reference demonstrates that all oral, non-interferon therapy has been demonstrated to be safe and effective in treatment naïve and previous failure to telaprevir or boceprevir. These favorable responses have also been seen in cirrhotic patients.

    Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Hope Hubbard declares that she has no conflict of interest. Dr. Eric Lawitz has been a consultant for Abbott Laboratories, Achillion Pharmaceuticals, Anadys Pharmaceuticals, Biolex Therapeutics, GlobeImmune, Inhibitex Pharmaceuticals, Merck & Co., Pharmasset, Santaris Pharmaceuticals, Tibotec, and Theravance. He has received grant support/pending grant support from Abbott Laboratories, Achillion Pharmaceuticals, Anadys Pharmaceuticals, Biolex Therapeutics, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, GlobeImmune, Idenix Pharmaceuticals, Idera Pharmaceuticals, Inhibitex Pharmaceuticals, Intercept Pharmaceuticals, Janssen, Medarex, Medtronic, Merck & Co., Novartis, Pharmasset, Roche, Schering-Plough, Santaris Pharmaceuticals, Scynexis Pharmaceuticals, Vertex Pharmaceuticals, ViroChem Pharma, and ZymoGenetics, as well as payment for lectures from Merck, Vertex, and Gilead.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by either of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eric Lawitz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hubbard, H., Lawitz, E. Real World Experience in the Era of First Generation Protease Inhibitors in the Treatment of Hepatitis C. Curr Hepatitis Rep 12, 189–194 (2013). https://doi.org/10.1007/s11901-013-0189-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11901-013-0189-z

Keywords

Navigation