Protease inhibitor-based triple therapy is highly effective for hepatitis C recurrence after liver transplant: a multicenter experience
Título del documento: Protease inhibitor-based triple therapy is highly effective for hepatitis C recurrence after liver transplant: a multicenter experience
Revista: Annals of hepatology
Base de datos: PERIÓDICA
Número de sistema: 000412867
ISSN: 1665-2681
Autors: 1
2
3
4
5
6
7
1
1
Institucions: 1University of Toronto, Toronto General Hospital, Toronto, Ontario. Canadá
2University of British Columbia, Vancouver, Columbia Británica. Canadá
3Montreal University, Quebec. Canadá
4McGill University, Quebec. Canadá
5University of Alberta, Edmonton, Alberta. Canadá
6University of Calgary, Calgary, Alberta. Canadá
7Western University, London, Ontario. Canadá
Any:
Període: Sep-Oct
Volum: 13
Número: 5
Paginació: 525-532
País: México
Idioma: Inglés
Tipo de documento: Artículo
Enfoque: Experimental
Resumen en inglés Hepatitis C (HCV) continues to be the leading indication for liver transplantation (LT). Sustained virological response (SVR) rates to pegylated interferon (PEG-IFN) and ribavirin (RBV) therapy for recurrent HCV in Genotype 1 (G1) LT recipients have been disappointing (30-40%). Experience with triple therapy using protease inhibitors (PI) boceprevir (BOC), telaprevir (TVR) in these patients has been limited. Material and methods. This national multicenter retrospective study included 76 patients (64 male, mean age 57 ± 6 years), treated for G1 HCV recurrence with either BOC (n = 41) or TVR (n = 35), who were non-responders or relapsers (n = 54), treatment naïve (n = 22) or had fibrosing cholestatic HCV (n = 3). 53 patients were on cyclosporine, 22 on tacrolimus and one patient on prednisone alone. Results. On treatment virologic response was observed in 84% (64/76), 83% in BOC and 85% in TVR group. A higher week 4 response after starting triple therapy (RVR) was noted in TVR group 25/35 (81%) as compared to BOC group 26/41 (63%); p value = 0.02. The end of treatment response was 78% and 75% in BOC and TVR group, respectively. SVR 12 weeks after treatment discontinuation was observed in 59.5% (22/37); 58.3% in the BOC group and 61.5% in TVR group. Treatment was discontinued early in 23 patients (serious adverse effects n = 19, treatment failure n = 4). Infections occurred in 5 patients with 2 deaths (all in BOC). Anemia was the most common side effect (n = 55, 72%) requiring erythropoietin and RBV dose reduction. In the BOC group, cyclosporine dose reduction was 2.2 ± 1.0 fold and 8.6 ± 2.4 fold with tacrolimus. In TVR group, dose reduction was 3.0 ± 1.4 with cyclosporine and 12 ± 5.7 fold with tacrolimus. Conclusions. PI-based triple therapy appears more effective in producing HCV-RNA clearance than dual therapy. Tolerability is a serious issue and drug-drug interactions are manageable with close monitoring
Disciplines Medicina
Paraules clau: Farmacología,
Gastroenterología,
Hepatitis E,
Boceprevir,
Telaprevir,
Respuesta sostenida,
Respuesta viral,
Interacción medicamentosa
Keyword: Medicine,
Gastroenterology,
Pharmacology,
Hepatitis C,
Boceprevir,
Telaprevir,
Sustained response,
Viral response,
Drug interaction
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