Immunosuppression, EVR predictive of SVR in liver transplant recipients with HCV

WASHINGTON — Sustained response to triple therapy among liver transplant recipients with chronic hepatitis C was significantly impacted by their immunosuppression regimen and achievement of early virologic response in a study presented at The Liver Meeting.

Researchers evaluated 79 liver transplant recipients with chronic HCV genotype 1 across 17 European centers between March 2011 and November 2012. The cohort (mean age, 56 years; 86% men) received treatment with pegylated interferon and ribavirin, along with either 800 mg boceprevir (n=35) three times daily with a 4-week lead-in phase, or 750 mg telaprevir three times daily with (n=19) or without (n=25) lead-in.

End-of-treatment response occurred in 60% of boceprevir recipients and 43% of telaprevir recipients (P=.176). Sustained virologic response at 12 weeks occurred in 51% of evaluable patients in the boceprevir group and 41% of the telaprevir group (P=.373). Among 17 patients who achieved SVR24, 47% were from the boceprevir group, compared with 27% in the telaprevir group (P=.132). No significant difference in treatment response was observed according to HCV genotype or prior response to dual therapy.

Multivariate analysis indicated that cyclosporine use before treatment (P=.0049) and no steroid use at baseline (P=.0083) were predictive of SVR12, while achieving early virologic response was the main predictive factor for SVR12 during therapy.

Early treatment discontinuation occurred in 48% of boceprevir patients and 61% of telaprevir patients. Discontinuation was attributed to adverse events in 20% and 42% of patients, respectively. The most commonly observed adverse event was anemia (90% of the cohort). Patients in the boceprevir group developed neutropenia significantly more frequently than telaprevir recipients (73% of cases vs. 45%; P=.011).

Infection was the most frequent serious adverse event, occurring in 33% of boceprevir recipients and 21% of telaprevir recipients. Multivariate analysis indicated that fibrotic cholestatic hepatitis at baseline predicted infection (P=.0473).

“Cyclosporine use and no steroids at baseline [were predictive of] SVR12,” presenter Audrey Coilly, MD, Centre Hepato-Biliaire, AP-HP, Hopital Paul Brousse in Villejuif, France, said. “During therapy, obtaining EVR was the main predictive factor of SVR12. Considering safety, which is one of the main issues of this kind of regimen, more than half of patients discontinued therapy prematurely, mostly due to adverse events.”

Disclosure: Coilly reported numerous financial disclosures.

For more information:

Coilly A. #216: Presidential Plenary: Viral Hepatitis: Sustained Virological Response After Protease Inhibitor-based Therapy for Hepatitis C Recurrence After Liver Transplantation: A Multicentric European Experience. Presented at: The Liver Meeting 2013; Nov. 1-5, Washington.