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Protease inhibitors improved sustained virologic response rate in HCV
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Data from a systematic review indicate triple therapy that included a protease inhibitor was more likely to achieve a sustained virologic response rate in patients with hepatitis C virus genotype 1 when compared with dual therapy.
According to the Annals of Internal Medicine report, the data also indicate that a sustained virologic response (SVR) after antiviral therapy was associated with improved clinical outcomes, including reduced mortality. For genotypes 2 and 3, the data indicate that current dual therapy regimens were supported, according to Roger Chou, MD.
Roger Chou
“Patients with genotype 1 infection may elect to use a triple therapy regimen,” Chou, an assistant professor of medicine at Oregon Health and Sciences University, told Infectious Disease News. “However, new, all oral, interferon-sparing regimens are expected within the new couple of years, which are possibly much better tolerated and convenient. “So, patients may choose to defer therapy in the short-term.”
Chou and colleagues conducted the review to compare benefits and harms of treatment in patients who had not yet received treatment. The review included randomized trials of antiviral treatments and cohort studies that were published from 1947 to August 2012.
Patients treated with pegylated interferon alfa-2b and ribavirin were less likely to have an SVR compared with those who received pegylated interferon alfa-2a and ribavirin (RR=0.87; 95% CI, 0.8-0.95). For patients with genotype 2 or 3 infection who received dual therapy, those who received 12 to 16 weeks of therapy were less likely to have an SVR compared with those who received 24 weeks of therapy.
Lower doses of pegylated interferon alfa-2b in dual therapy were associated with fewer SVRs. A 48-week triple-therapy regimen including boceprevir (Victrelis, Merck) or telaprevir (Incivek, Vertex) was associated with an SVR compared with dual therapy. However, boceprevir triple therapy was associated with more hematologic adverse events and telaprevir triple therapy was associated with anemia and rash.
“Additional research would be helpful to define the benefits and harms in subgroups of patients, defined by age, race, sex, body weight and others,” Chou said. “Also, more data are needed to better understand the ultimate effects of antiviral therapy on clinical outcomes that controls for potential confounders.”
Disclosure: Some researchers have received grant funding from the Agency for Healthcare Research and Quality.
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