Triple combination therapy for hepatitis C with telaprevir exhibits greater early antiviral activity than with boceprevir

Antivir Ther. 2013 May 3. doi: 10.3851/IMP2614. [Epub ahead of print]

Benito JM, Sánchez-Parra C, Maida I, Aguilera A, Rallón NI, Rick F, Labarga P, Fernández-Montero JV, Barreiro P, Soriano V.

Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain.

Abstract

BACKGROUND: Achievement of early viral suppression is important in patients with chronic hepatitis C virus (HCV) infection treated with telaprevir (TLV) or boceprevir (BOC) to avoid selection of drug resistance and attain cure. No head-to-head studies comparing TLV and BOC have been performed so far.

METHODS: All consecutive individuals that initiated triple HCV therapy with TLV or BOC outside clinical trials at three European clinics were evaluated. Rapid virological response (RVR) was defined as unquantifiable HCV-RNA (<25 IU/mL) at week 4 for TLV and at week 8 for BOC (4 weeks after lead-in).

RESULTS: A total of 106 patients were evaluated, 33 treated with BOC and 73 with TLV. Median age, gender, BMI, baseline HCV-RNA, HCV subtype 1a (45% vs 42%), IL28B-CC alleles (29% vs 23%) did not differ significantly in BOC and TLV groups, respectively. HIV coinfection was more prevalent in patients on TLV than BOC (24% vs 44%). Conversely, more patients on BOC than TLV had previously failed to peginterferon-ribavirin (82% vs 64%). RVR was achieved by 82% of patients on TLV vs 59% on BOC (p=0.001). Multivariate logistic regression analysis (OR [95% CI], p) confirmed that TLV use was the strongest predictor of RVR (3.54 [1.23-10.24], 0.02), being others HCV subtype 1b vs 1a (3.26 [1.17-9.09], 0.02) and low baseline HCV-RNA (0.41 [0.16-1.03], 0.06). Prior interferon exposure, HIV coinfection or absence of advanced liver fibrosis did not influence the likelihood of RVR.

CONCLUSIONS: Compared to BOC, triple therapy with TLV produces greater RVR rates. TLV might be a better option in more difficult-to-cure patients, such as those with high baseline HCV-RNA and/or HCV 1a subtype. HIV coinfection does not influence early HCV-RNA responses.

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