Treatment of Recurrent Genotype 1 Hepatitis C Post-Liver Transplantation: Single Center Experience with Telaprevir-Based Triple Therapy

Abstract

Recurrent HCV infection post-liver transplantation (post-LT) is still a major challenge in the treatment of hepatitis C virus (HCV) infection. In this retrospective analysis we gathered data about treatment response and safety of all 14 post-LT patients who were treated between 2011 and 2013 at our centre with a telaprevir (TVR)-based triple therapy. Seven out of 14 patients completed the full treatment course of 48 weeks. Five patients achieved a SVR 24, while 3 additional HCV RNA-negative patients are still in follow-up (end of treatment, SVR 12 and 22). Four patients discontinued treatment prematurely due to side effects. A virological non-response at TW 4 was seen in 1 patient. Virological breakthrough was observed in 2 patients at TW 16 and 28, respectively; 1 patient displayed a virological relapse after the end of treatment (EOT). Patients with a complicated course post-LT accumulated most of the severe side effects, largely infections. One patient with cholestatic hepatitis died 11 weeks after discontinuation of treatment due to progressive graft failure. In conclusion, TVR-based triple therapy in post-LT patients reveals an acceptable antiviral efficacy. Unfortunately, severe side effects are frequent and often require therapeutic interventions. Therefore, with the approval of less straining DAA like sofosbuvir in sight, TVR-based triple therapy in post-LT patients should be, if possible avoided.

Pharmacodynamic monitoring of immunosuppressive effects indicates reduced cyclosporine activity during telaprevir therapy

“…If we assume a best case scenario, a cure rate of 100% for post‐OLT patients with HCV genotype 1 could be achieved in our cohort. This is far better than a maximum SVR 24 rate of 57% or SVR 12 rates of 20% and 62%, respectively. Our study underlines the significance of a rapid virological response (RVR) for SVR.…”

“…Interim data from a prospective, multicenter study assessing the safety, efficacy, and pharmacokinetics of TVR in combination with PEG‐IFN and RBV in liver transplant recipients showed that 47% and 82% of the patients were HCV RNA–negative at treatment weeks (TWs) 4 and 12, respectively . Further reports of single and multicenter cohorts of these difficult‐to‐treat patients undergoing triple therapy revealed a 57% rate of sustained virological response at 24 weeks (SVR 24) and 20% and 62% rates of sustained virological response at 12 weeks (SVR 12). Therefore, triple therapy after OLT almost seems to double the treatment success of antiviral therapy in comparison with dual therapy with PEG‐IFN and RBV, with which SVR rates are approximately 30% …”

Pharmacoeconomic Assessment of Using Interferon-Free Regimens for Chronic Hepatitis C After Liver Transplantation

“…et al [29] 9 ПИФН + РБВ + Телапревир -89,0 Ann Brown K. et al [30] 46 ПИФН + РБВ + Телапревир -46,0 Faisal N. et al [31] 76 ПИФН + РБВ + Телапревир -61,5 ПИФН + РБВ + Боцепревир -58,3 Werner C.R. et al [32] 14 ПИФН + РБВ + Телапревир -50,0…”

Successful Anti-HCV Therapy of a Former Intravenous Drug User with Sofosbuvir and Daclatasvir in a Peritranspant Setting: A Case Report

“…In the past, an interferon (IFN)-based antiviral therapy combined with the nucleoside analogue ribavirin (RBV) was the hallmark of treatment of CHC, but success rates remained unsatisfactory even after the introduction of the first generation of DAAs such as telaprevir and boceprevir [12–26]. …”