Efficacy of telaprevir and boceprevir in treatment-naïve and treatment-experienced genotype 1 chronic hepatitis C patients : an indirect comparison using Bayesian network meta-analysis

Curr Med Res Opin. 2012 Sep 27. [Epub ahead of print]

Cure S, Diels J, Gavart S, Bianic F, Jones E.

Abstract

BACKGROUND & AIMS: To indirectly compare the efficacy of telaprevir (TVR) and boceprevir (BOC) combined with peginterferon/ribavirin α-2a/2b (PR) in achieving sustained viral response (SVR) in treatment-naïve and treatment-experienced patients with genotype 1 chronic hepatitis C virus (HCV) infection.

METHODS: A systematic literature review was conducted to identify randomized controlled trials reporting the efficacy of PR-based treatment in genotype 1 chronic HCV patients. A Bayesian network meta-analysis was performed on the endpoint of SVR, assuming fixed study effects. For treatment-experienced patients, only previous relapsers and partial responders were included, as no results in prior null-responders were available for boceprevir.

RESULTS: 11 publications were included. In treatment-naïve patients, the odds ratios (OR) (posterior median [95% credible interval]) for telaprevir (12 weeks + Response Guided Treatment (RGT) 24/48 weeks PR) and boceprevir (24 weeks + RGT 28/48 weeks PR) versus PR were respectively 3.80 [2.78-5.22] and 2.99 [2.23-4.01]. The OR between telaprevir versus boceprevir was 1.42 [0.89-2.25], with a probability for telaprevir being more effective (P[OR>1]) of 0.93. In treatment-experienced patients, the OR of telaprevir (12 weeks + 48 weeks PR) and boceprevir (32 weeks + RGT 36/48 weeks PR) versus PR were respectively 13.11 [7.30-24.43] and 5.36 [2.90-10.30]. The OR between telaprevir versus boceprevir was 2.45 [1.02-5.80], with telaprevir having a probability of 0.98 for being more effective. The main limitation of this study is the low number of trials included in the analysis, especially for the treatment-experienced patient population, which only allowed to explore random-effect models. We tried to identify potential biases due to study heterogeneity.

CONCLUSIONS: In the absence of direct comparative head-to-head studies between telaprevir and boceprevir for the treatment of chronic HCV genotype 1 patients, an indirect comparison based on Bayesian network meta-analysis suggests better efficacy for telaprevir than boceprevir in both treatment-naïve and treatment-experienced patients.

PMID: 23016967 [PubMed - as supplied by publisher]

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