A recent study found that the hepatitis C virus decays during treatment with telaprevir faster in the bloodstream than it does in the liver, a discovery that could help pinpoint how long a patient needs to take medicine to rid the virus from the body.
“We found that HCV RNA decay in the liver lagged behind that in the
peripheral blood, which has implications for how long the virus may
persist in the body and the possible duration of treatment needed,”
Andrew Talal, MD, said in the statement. Higher levels of telaprevir were also found
in blood when compared to the liver.
Before this study, there was no precise definition of treatment duration
based upon serial measurements of the virus in the liver, according to
WASHINGTON, D.C. — Israeli patients with hepatitis C virus infection
genotype 1 showed varied improvements after protease inhibitor-based
triple therapy, according to data presented at ICAAC 2014.
Researchers at the Soroka Medical Center in southern Israel treated 55 outpatients with hepatitis C virus (HCV) genotype 1 with telaprevir (n=39) or boceprevir (n=16) in combination with pegylated interferon and ribavirin between September 2011 and November 2013. Patients were followed for 6 months post-treatment.
“In our experience, protease inhibitor-based triple regimen for HCV
genotype 1, though more effective than previous dual treatment, is still
limited in effectiveness and holds major safety issues,” the
researchers wrote. “In light of the era where new, much more effective
and safe [direct-acting antivirals] begin to emerge, the triple therapy
in our view should be given mainly to patients with advanced disease
that cannot wait for the new drugs to be available and affordable.”
Older patients with hepatitis C experienced more adverse events and more
serious adverse events while treated with boceprevir or telaprevir, and
they discontinued treatment more frequently than did their younger
peers, according to data from the HCV-TARGET trial.
Dr. Andrew Aronsohn of the University of Chicago and
his colleagues studied a subset of HCV-TARGET that comprised 1,100
patients who started treatment on a direct-acting antiviral agent before
Hypothyroidism is a somewhat common condition in
people with hepatitis C. While there were only 4 reported cases in this
study, it is important that people who take levothyroxine—the most
common treatment for hypothyroidism—are monitored on a regular basis
while on telaprevir therapy. –Alan Franciscus
Telaprevir Interferes with Levothyroxine Treatment of Hypothyroidism
Therapy for chronic hepatitis C (HCV) is associated
with a variety of side effects and drug interactions but interference
with levothyroxine treatment of hypothyroidism has not been reported.
We describe four patients with hypothyroidism treated with
levothyroxine started on therapy with telaprevir, ribavirin, and peg
interferon-alpha 2a in whom a sharp rise in thyroid stimulating hormone
(TSH) was observed.
This increase resolved with cessation of telaprevir. Interferon and ribavirin were continued to the completion of therapy.
Eligible HCV triple therapy
patients at our institution have TSH drawn at baseline and weeks 2, 4,
6, 8 and 12. In 4 of 4 patients taking levothyroxine replacement TSH
increased significantly. This TSH elevation persisted despite increases
in levothyroxine dosages and asking patients to take the levothyroxine
on an empty stomach in the morning at least 2 hours before any food or
This is the first report of reversible interference
between levothyroxine treatment of hypothyroidism and telaprevir.
Possible explanations for this effect include protein-binding
competition between telaprevir and hormone, a change in T4 metabolism, a
decrease in T4 production, or a decreased conversion of T4 to T3.
More formal studies will need to be completed to decipher the exact mechanism(s) of this interaction.
Telaprevir-based triple therapy outweighed risks for adverse events
Researchers reported that the treatment benefits associated with
telaprevir-based triple therapy for HCV offset any problems with adverse
events, and recommended the therapy for patients with advanced
In a prospective multicenter study, 102 patients with advanced fibrosis
who were infected with HCV genotype 1b received 12 weeks of telaprevir
(TVR) in combination with 24 weeks of pegylated interferon alfa-2b
(Peg-IFN a-2b) and ribavirin (RBV).
Severe anemia risk remains in TVR-based triple therapy for HCV
Patients with HCV who were treated with telaprevir in combination
with pegylated interferon alfa-2b and ribavirin therapy remained at a
significantly increased risk for severe anemia, recent study results
Researchers examined the risk for severe anemia
in 292 patients (mean age, 62 years) infected with HCV genotype 1 who
were assigned telaprevir (TVR) in combination with pegylated interferon
alfa-2b (Peg-IFN a-2b) and ribavirin (RBV) for 12 weeks. Severe anemia
was defined as hemaglobin (Hb) levels lower than 85 g/L.
Telaprevir triple therapy shows activity against HCV genotype 4
The HCV protease inhibitor telaprevir (Incivek or Incivo) in
combination with pegylated interferon and ribavirin reduced viral levels
by more than 4 log in people with genotype 4 hepatitis C in a short
Phase 2a study, researchers reported in the September 15, 2013 Journal of Infectious Diseases.
The advent of direct-acting antiviral agents (DAAs) has brought about a
new era of treatment for hepatitis C virus (HCV), enabling
shorter-duration therapy with a higher likelihood of sustained
virological response — generally considered a cure. Second-generation
agents now in development are more effective and better tolerated, and
interferon-free regimens are on the horizon.
New protease inhibitors showing promise for HIV/HCV coinfection
Although use of telaprevir or boceprevir in the HIV/HCV coinfected
patient would be considered off-label, consideration should be given to
utilizing these agents when HCV treatment is desired because the current
evidence shows a substantial improvement in treatment success.
This is an exciting time in the treatment of chronic hepatitis C
virus infections. As opposed to the antibiotic pipeline, there are a
number of new antiviral agents for treatment of hepatitis C in
development that may transform the way these patients are treated.
Chronic infection with HCV has emerged as a major cause of morbidity
and mortality in those living with HIV infection. Approximately 15% to
30% of patients with HIV in the United States are estimated to be
coinfected with HIV and HCV. All patients with HIV/HCV coinfection
should be evaluated for HCV therapy because of the more rapid
progression of liver disease in those with HCV alone, and because the
successful treatment of HCV may also reduce the risk for hepatotoxicity
from the use of HAART in these patients.