How to optimize current therapy of HCV genotype 1 infection with boceprevir

Abstract

Treatment with first generation protease inhibitors (PIs) is a milestone in the history of HCV therapy. Triple therapy with boceprevir (BOC) improves sustained virological response (SVR) by 30% in treatment na€ ıve genotype 1 patients and by 50-60% in relapsers, 40-45% in partial responders and 25% in null responders compared with the Pegylated Interferon (PEG-IFN) and ribavirin regimen. To optimize BOC treatment, screening and access to treatment must be improved in genotype 1 patients. To select the ideal candidate for immediate treatment with triple therapy, an individual risk/benefit ratio must be assessed. Recent data have shown that patients with compensated cirrhosis and more advanced disease may also benefit from this regimen. Moreover, in HCV patients with extrahepatic manifestations, patients with HCV recurrence after liver transplantation and HIV-HCV co-infected patients, immediate treatment with triple therapy should be discussed. There is growing evidence that triple therapy with BOC is cost-effective in genotype 1 patients. Finally, the treatment design of BOC must be optimized in relation to baseline characteristics, so that optimal stopping rules can be followed, Drug-drug interactions (DDIs) can be prevented and AEs can be accurately prevented and managed.Chronic hepatitis C virus (HCV) infection is a major cause of cirrhosis and hepatocellular carcinoma and is the main cause of liver transplantation worldwide. This global health problem affects more than 160 million people in the world (1). Liver related morbidity and mortality from all causes can be significantly reduced by the eradication of the virus (2). Until 2011 the treatment of HCV was based on a combination of pegylated interferon alpha and ribavirin (PEG-IFN/RBV) and less than 50% of HCV genotype 1 infected patients achieved a sustained virological response (SVR) (3-5). In the last decade, antiviral therapy reduced the cumulative incidence of cirrhosis by 7% and of liver related deaths by 3.4% overall in western European countries (6). The launch of first generation protease inhibitors (PI) boceprevir (BOC) and telaprevir (TLV) in 2011 dramatically improved SVR rates in genotype-1 patients (7-13). In phase III studies, SVR rates improved by nearly 30% with triple therapy with both PI compared with PEG-IFN/RBV, reaching 63 with BOC and 75% with TLV in treatment na€ ıve genotype-1 patients. The benefit was even greater in treatment-experienced patients: the chance of a SVR increased by 50-60% in relapsers, 40-45% in partial responders and 25% in null responders compared with the PEG-IFN/RBV regimen. The global SVR rate of triple therapy is 59-66% in treatment-experienced patients. However, this fantastic progress is accompanied by additional as well as more severe adverse events (SAEs), increased costs of treatment and new drug-drug interactions.The aim of this article is to review available data to optimize the current use of BOC in HCV Genotype-1 patients in relation to patient selection as well as treatment design. We will di...

Management of Chronic Hepatitis C Virus Infection: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases

“…Hafif fibrozu olan hastalarda tedavinin maliyetetkin olup olmayacağı bilinmemektedir. Son veriler, üçlü tedaviyle, yaşam süresi maliyetinin F2 fibrozlu hastalarda, F3 ve F4 fibrozu olanlara göre daha fazla maliyet-etkin olacağını düşündürmektedir (45,46). PegIFN içermeyen oral rejimlerin HCV genotip 1 ile infekte hastalarda fibroz derecesine bakıl-maksızın maliyet-etkin bir yaklaşım olabileceği bildirilmiştir (47).…”