December 22, 2013

Clinical Gastroenterology and Hepatology

Article in Press

George N. Ioannou, Lauren A. Beste, Pamela K. Green

Received 14 October 2013; received in revised form 18 November 2013; accepted 2 December 2013. published online 19 December 2013.
Accepted Manuscript

Abstract

Background

& Aims: We investigated the real-world effectiveness of triple therapy regimens against hepatitis C virus (HCV) and compared rates of sustained virologic response (SVR) between telaprevir- and boceprevir-based regimens in a population-based study.

Methods

We analyzed data on all patients in the Veterans Administration (VA) healthcare system who were infected with HCV genotype 1 and began treatment with pegylated interferon, ribavirin, and either boceprevir (n=3696, 83%) or telaprevir (n=759, 17%) from June 2011 through February 2013.

Results

Patients treated with telaprevir were more likely to have baseline characteristics associated with not achieving SVR than patients treated with boceprevir. Fewer than half of patients eligible for short-duration regimens (28 weeks for boceprevir, 24 weeks for telaprevir) successfully completed treatment (37% for boceprevir, 27.5% for telaprevir); ∼25% discontinued early and the remaining patients were treated for longer durations. Of patients who were supposed to complete 48-week regimens, only 35% of boceprevir- and 34% of telaprevir-treated patients completed >44 weeks. The rate of SVR was 51.5% overall, 42.7% among patients with cirrhosis, 56.8% among treatment-na├»ve patients, 64.2% among prior relapsers, 31.7% among prior partial-responders, and 29.8% among prior null responders. There were no significant differences in rate of SVR between patients given boceprevir or telaprevir, in the entire population or among subgroups. The most important predictors of failure to achieve SVR were IL28B genotype, high viral load, Black race, diabetes, high APRI or FIB-4 scores, low platelet counts, or low levels of low-density lipoprotein cholesterol. Erythropoietin use was not associated with SVR.

Conclusions

In a nationwide analysis of Veterans with HCV genotype 1 infection, rates of SVR are similar for those treated with boceprevir vs telaprevir. However, rates of treatment completion and SVR in real clinical practice are substantially lower than those in clinical trials.

Keywords: DAA, antiviral therapy, population, APRI, outcome, LDL

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