How to optimize HCV therapy in genotype 1 patients: predictors of response
- 3 January 2013
- journal article
- review article
- Published by Wiley in Liver International
- Vol. 33, 23-29
- https://doi.org/10.1111/liv.12053
Abstract
The advent of triple therapy (TT) with first-generation protease inhibitors boceprevir (BOC) and telaprevir (TVR) in addition to pegylated interferon and ribavirin (PEG-IFN/RBV) has resulted in a significant improvement in the sustained virological response (SVR) rate and potentially in life years gained compared to dual therapy (DT), when treating naïve or treatment-experienced patients with genotype 1 (G1) chronic hepatitis C (CHC). This benefit is partly offset by the increased complexity of treatment, and the increased costs and risks of therapy, making it necessary to optimize the indications for TT. Naïve patients with mild fibrosis and the IL28B CC polymorphism and/or with a rapid virological response (RVR) to DT can still benefit from DT, while TT is preferable in all others. Phase 3 trials have clearly shown that a 1 log(10) decrease in HCVRNA after 4 weeks of DT associated with a favourable IL28B genotype and a low stage of fibrosis, and a pattern of previous response to DT in treatment-experienced patients are the strongest predictors of an SVR to TT. Moreover, an extended rapid virological response (eRVR) is associated with an SVR rate >90%, so that the overall duration of treatment can be shortened in a high proportion of patients. Further efforts to optimize the current TT regimens both by increasing efficacy and improving tolerance are still needed. Most important, in the future, treatment can probably be personalized based on data from post-marketing surveillance of TT providing information about patient groups that were underrepresented in phase 3 studies such as those with cirrhosis.This publication has 21 references indexed in Scilit:
- Cost-effectiveness of boceprevir or telaprevir for untreated patients with genotype 1 chronic hepatitis CJournal of Hepatology, 2012
- New direct-acting antiviral agents for the treatment of hepatitis C virus infection and perspectivesGut, 2012
- Response-Guided Telaprevir Combination Treatment for Hepatitis C Virus InfectionThe New England Journal of Medicine, 2011
- Telaprevir for Previously Untreated Chronic Hepatitis C Virus InfectionThe New England Journal of Medicine, 2011
- Telaprevir for Retreatment of HCV InfectionThe New England Journal of Medicine, 2011
- Boceprevir for Untreated Chronic HCV Genotype 1 InfectionThe New England Journal of Medicine, 2011
- Boceprevir for Previously Treated Chronic HCV Genotype 1 InfectionThe New England Journal of Medicine, 2011
- EASL Clinical Practice Guidelines: Management of hepatitis C virus infectionJournal of Hepatology, 2011
- Interleukin-28B Polymorphism Improves Viral Kinetics and Is the Strongest Pretreatment Predictor of Sustained Virologic Response in Genotype 1 Hepatitis C VirusGastroenterology, 2010
- Shortened treatment duration in treatment-naive genotype 1 HCV patients with rapid virological response: A meta-analysisJournal of Hepatology, 2010