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. 2013 Sep;72(9 Suppl 4):6-13.

New triple therapy for chronic hepatitis C: real life clinical experience in a community setting

Matthew J Akiyama  1 , Joy I Piotrowski, Marina M Roytman, Siu M A Chan, Leena K Hong, Leslie Huddleston, Ruby Trujillo, Naoky C S Tsai
Affiliations

New triple therapy for chronic hepatitis C: real life clinical experience in a community setting

Matthew J Akiyama et al. Hawaii J Med Public Health. 2013 Sep.

Abstract

Recent advances in treatment of chronic hepatitis C virus have improved significantly due to the introduction of two new protease inhibitors-telaprevir and boceprevir. In combination with the previous standard of care, peginterferon and ribavirin, telaprevir and boceprevir have demonstrated improved sustained virologic response rates for HCV genotype 1 patients by approximately 30%. The purpose of this study was to assess the validity of large clinical trial data with respect to efficacy and side effects in a community setting in Honolulu, Hawai'i. This retrospective study was performed by reviewing the charts of 59 chronic HCV patients who were started on triple therapy from July 1, 2011 to July 7, 2012. Sustained virologic response was attained by 73% of patients treated with telaprevir and 46% of patients treated with boceprevir respectively. Our clinical experience with telaprevir demonstrates that SVR rates are compatible with published literature values. Rates of SVR in our cohort were also similar to those reported in cirrhotic patients - about 50%. Due to small number of patients treated with a boceprevir-based regimen, it is difficult to compare our experience with pivotal trial experience. The side effect profiles for the two protease inhibitors were similar to the literature values except for more rectal irritation and a higher incidence and severity of anemia on telaprevir therapy in the clinical setting. While not intended to be conclusive, our study demonstrates that clinical trial data are largely compatible with the outcomes obtained in our community setting.

Keywords: HCV; Incivek; Victrelis; boceprevir; community experience; real clinical setting; telaprevir; triple therapy.

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Figures

Figure 1
Figure 1
Percentage of patients on each protease inhibitor who achieved eRVR with annotation of those who continued on to achieve SVR.
Figure 2
Figure 2
Percentage of patients treated with protease inhibitor that achieved SVR.
Figure 3
Figure 3
Percentage of patients on TVR who attained SVR. Comparison by prior treatment category between our clinical experience and published literature values in the ADVANCE and REALIZE trials.
Figure 4
Figure 4
Changes in HCV RNA levels. Shown are changes in mean log10 HCV RNA levels over the study period for patients on TVR and BOC who attained SVR.
Figure 5
Figure 5
Percentage of cirrhotic patients on TVR who achieved SVR. Comparison between our clinical experience and published literature values found in ADVANCE and REALIZE trials.
Figure 6
Figure 6
TVR patient side effects in comparison to the published literature values found in the ADVANCE and REALIZE trials.
Figure 7
Figure 7
Percentage of patients treated with each drug that required treatment for anemia (prescribed growth factors or blood transfusions) in comparison to the published literature value for telaprevir and boceprevir.
See this image and copyright information in PMC

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