Given the high side-effect profile of the current HCV protease combination therapy, it is good to know that there are some genotype 1 patients who can be cured without including an HCV protease inhibitor. This study compared treatment with PEG/RBV to PEG/RBV plus a protease inhibitor (boceprevir). The results were similar between the two groups if the study participants achieved a rapid virological response – RVR (4 weeks of PEG/RBV).
Good news for some people who should be treated now rather than waiting for newer therapies that will also include PEG/RBV.
—Alan Franciscus, Editor-in-Chief, HCV Advocate
Center for Hepatitis C, Atlanta Medical Center, Atlanta, GA; Graduate Medical Education Department, Atlanta Medical Center, Atlanta, GA; Medical College of Georgia, Department of Medicine, Augusta, GA; Emory University School of Medicine, Department of Medicine, Atlanta, GA.
Hepatology. 2013 Jul 19. doi: 10.1002/hep.26624. [Epub ahead of print]
Pearlman BL, Ehleben C.
Abstract: Hepatitis C genotype 1 virus with low viral load and rapid virologic response to peginterferon/ribavirin obviates a protease inhibitor.
The new standard of care for treatment-naïve patients with hepatitis C virus (HCV) genotype 1 includes triple therapy with peginterferon, ribavirin, and a protease inhibitor. However, patients who achieve a rapid virologic response after 4 weeks of peginterferon and ribavirin therapy are likely to achieve a sustained virologic response (SVR), and we hypothesized that protease inhibitor therapy may be unnecessary in these patients.
Treatment-naïve, non-cirrhotic patients infected with genotype-1 HCV and a low viral load at baseline were considered for inclusion (n = 233). After 4 weeks of lead-in therapy with peginterferon α-2b and ribavirin, 101 patients (48%) had a rapid virologic response (defined as undetectable levels of hepatitis C virus RNA at 4 weeks) and were eligible to participate.
Patients were randomized 1:1 to 20 weeks of additional therapy with peginterferon α-2b and ribavirin (double therapy) or to 24 weeks of peginterferon α-2b, ribavirin, and boceprevir (triple therapy). There was no significant difference in rates of SVR-12 in patients treated with double versus triple therapy. This similarity persisted regardless of viral subtype (genotype 1a or 1b), interleukin (IL)-28b genotype (CC or non-CC), or ethnicity (African American versus non-Hispanic white).
Protease inhibitor therapy could be obviated in genotype 1-infected treatment-naïve patients with low viral load at baseline who achieve undetectable viremia after 4 weeks of peginterferon/ribavirin. (Hepatology 2013;).
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