Chronic Hepatitis C Therapy in Liver Cirrhosis Complicated by Telaprevir-Induced DRESS

Mousa, Omar Y.; Khalaf, Rossa; Shannon, Rhonda L.; Egwim, Chukwuma; Zela, Scott; Ankoma‐Sey, Victor

doi:10.1155/2014/380424

Cited by 10 publications

(7 citation statements)

References 17 publications

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“…14,[26][27][28] Cases of SCARs occurred only in TVR group during clinical trials and they were also reported in post registration's studies. 12,14,26,[29][30][31][32][33][34][35] The most common skin rashes reported during the study were characterized as mild or moderate (24 patients -85,72%). The morphological pattern of skin rashes was similar in all patients.…”

Section: Discussionmentioning

confidence: 99%

Dermatologic adverse events of protease inhibitor-based combination therapy in patients with chronic hepatitis C

Kłujszo¹,

Parcheta²,

Zarębska-Michaluk

et al. 2014

J Dermatol Case Rep

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Background: Combination therapy with pegylated interferon, ribavirin and a firstgeneration NS3/4A protease inhibitor, telaprevir or boceprevir, is the new strategy for treatment of genotype 1 chronic hepatitis C virus infection. This combination improves therapeutic efficacy but it also increases the risk of adverse events. Objective:The aim of the study was to analyze frequency and severity of dermatological adverse events during protease inhibitor-based therapy and to evaluate the risk factors for their development. Patients and methods:This is a retrospective study of 109 patients with genotype 1 chronic hepatitis C treated with boceprevir (n=33) or telaprevir (n=76) based triple therapy. A logistic regression for relationship between clinical, demographic and laboratory factors and cutaneous adverse events was performed.Results: Dermatological adverse events (skin rash, pruritus, anorectal paresthesia) occurred in both treatments (boceprevir and telaprevir) with similar frequency: 28% in telaprevir and 21% in boceprevir. In patients treated with telaprevir, men were more predisposed to develop skin rashes compared to women (OR 4,1 p=0,014) and age above 45 years was associated with occurrence of pruritus in men (OR 8,16 p=0,014). Being a female, coexistence of autoimmune thyroiditis and advanced liver fibrosis were independent factors predisposing to development of anorectal paresthesia (OR 4,13 p=0,041, OR 4,25 p=0,029, OR 4,54 p=0,018 respectively) in this group. In patients treated with boceprevir, coexistence of autoimmune thyroiditis predisposed to skin rashes (OR 10,22 p=0,017) and being a female predisposed to pruritus (OR11,2 p=0,033). The adverse events occurred after a mean time of 8,6 (range 1-24) weeks after initiation of therapy. Conclusions:In patients with chronic hepatitis C who received the triple therapy, the anorectal paresthesias were observed only in patients treated with telaprevir. The predisposing factors for this adverse event were: female gender and advanced liver fibrosis. The risk factors for other dermatological adverse were: 1) being a male over 45 years, for skin rashes and pruritus (for telaprevir), 2) coexistence of autoimmune thyroiditis for skin rashes (for boceprevir), 3) being a female, for pruritus (for boceprevir). (J Dermatol Case Rep. 2014; 8(4): 95-102)

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Section: Discussionmentioning

confidence: 99%

Dermatologic adverse events of protease inhibitor-based combination therapy in patients with chronic hepatitis C

Kłujszo¹,

Parcheta²,

Zarębska-Michaluk

et al. 2014

J Dermatol Case Rep

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“…Usually, the secondary cutaneous eruption to these medications presents as a pruriginous, erythematous macule and papule, with fine desquamation, affecting extensor surfaces of members and trunk [ 13 ]. There are reports of drug reaction with eosinophilia and systemic symptoms (DRESS), toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) [ 5 , 14 , 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some diseases such as cryoglobulinemia, polyarteritis nodosa and erythema multiformis are commonly seen in association with hepatitis C [ 10 ]. Skin biopsy is also not specific, but it is important for the differential diagnosis with other causes of vasculitis, infectious exanthemas or autoimmune diseases [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Eruption due to Telaprevir

Falcão¹,

Trope²,

Godinho³

et al. 2015

Case Rep Dermatol

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Hepatitis C virus (HCV) chronically infects 0.5-3% of the world population. A large group of patients develop cirrhosis and its complications. Since 2011, telaprevir and boceprevir are used, improving the disease evolution. One of the main side effects of these drugs is skin eruption. We report a 53-year-old patient with cirrhosis due to HCV who started the classic treatment associated with telaprevir. In the ninth week, he presented a severe rash that required the interruption of this drug. We emphasize the importance of early recognition and appropriate management of adverse skin reaction.

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“…Severe complications related to this therapy included hepatic decompensation, renal failure, severe infections, asthenia, and a variety of hematological abnormalities, including anemia (requiring erythropoietin and/or blood transfusion), neutropenia (requiring granulocyte‐stimulating agent), and thrombocytopenia (requiring thrombopoietin) . Furthermore, patients receiving TVR were at higher risk for experiencing severe cutaneous adverse reactions including drug rash with eosinophilia and systemic symptoms and toxic epidermal necrolysis, as well as anorectal discomfort and pruritus. Patients who underwent TVR‐based triple therapy were at higher risk for SAEs than patients who received a BOC regimen.…”

Section: Safety Outcomesmentioning

confidence: 99%