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
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 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.