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.
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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.
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.
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.
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.
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.
Poordad F, McCone J, Bacon BR, et al. Boceprevir for untreated chronic HCV genotype 1 infection. N Engl J Med. 2011;364:1195–206.
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.
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.
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.
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.
Zeuzem S, Andreone P, Pol S, et al. Telaprevir for retreatment of HCV infection. N Engl J Med. 2011;364:2417–28.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
•• 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.
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.
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.
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.
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.
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.
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.
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.
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.
Lawitz E, Mangia A, Wyles D, et al. Sofosbuvir for previously untreated hepatitis C infection. N Engl J Med. 2013;368:1878–87.
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.
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.
• 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..
• 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.
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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.
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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
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DOI: https://doi.org/10.1007/s11901-013-0189-z