A practical guide for the use of boceprevir and telaprevir for the treatment of hepatitis C

Abstract

The aim of this study is to review clinical trial data on the newly approved protease inhibitors boceprevir and telaprevir to develop consensus recommendations on the optimal use of these agents for the treatment of patients with chronic hepatitis C virus (HCV) infection. An expert panel of seven leading authorities in viral hepatitis was convened to establish and disseminate a practical guide on best practices for incorporating boceprevir and telaprevir into therapy for HCV infection in both treatment-naive and treatment-experienced patients. The topics covered include selecting candidates for boceprevir- or telaprevir-based treatments, predictors of response and early viral kinetics, response-guided therapy approaches, on-treatment management strategies to optimize the likelihood of response and minimize the risk of drug resistance, management of adverse effects during therapy and key considerations for special populations. The expert panel incorporated the best available clinical evidence into recommendations on how boceprevir and telaprevir should be used in the clinical setting. They indicated how treatment regimens may differ according to the baseline factors, such as presence of cirrhosis and when therapy may need to be modified or stopped altogether because of adverse events or poor virologic response. This practical guide will serve as a valuable resource for clinicians embarking on the new treatment paradigm of boceprevir or telaprevir in combination with peginterferon/ribavirin for chronic genotype 1 HCV infection.

In Vitro and In Vivo Antiviral Activity and Resistance Profile of Ombitasvir, an Inhibitor of Hepatitis C Virus NS5A

“…For the treatment of HCV genotype 1, three HCV NS3/4A protease inhibitors (telaprevir, boceprevir, and simeprevir) and one nucleoside NS5B polymerase inhibitor (sofosbuvir), each in combination with pegylated interferon (pegIFN) and ribavirin (RBV), have received marketing approval in the United States and Europe. The sustained virologic response (SVR) rate increased from 40 to 52% with pegIFN and RBV regimens to 67 to 75% when telaprevir and boceprevir were used in combination with pegIFN and RBV (16,17). The NS3/4A protease inhibitor simeprevir in combination with pegIFN and RBV improved the SVR rate to 80%, but in genotype 1a-infected patients with a Q80K polymorphism in the HCV NS3 protein, the SVR rate was reduced to 58% (18,19).…”

Peg-interferon plus ribavirin with or without boceprevir or telaprevir for HCV genotype 1: A meta-analysis on role of response predictors

“…In spite of general agreement in defining triple therapy more effective than dual therapy [11][12][13][14][15][16], supported by the results of two recent metaanalyses [17,18] and studies using a Bayesian indirect treatment comparison model [19,20], it is still a matter of debate whether the above-mentioned predictors can identify subsets of patients who could benefit more from dual than triple therapy in terms of response to treatment and/or serious adverse events.…”

The evolution of the therapeutic strategy in hepatitis C: Features of sofosbuvir and indications

“…Although there is solid evidence that patients achieving a sustained virological response (SVR) with definitive virus eradication with these regimes have a clear clinical benefit on long term disease complications and survival, this favourable outcome is achieved only in a subgroup of patients and in a small minority of those with more advanced liver disease, which are in more evident and urgent need of cure [3,4]. Furthermore, side effects are frequent and may be severe in individual cases, and many patients cannot be initiated on therapy due to contraindications, or are reluctant to receive Interferon.…”