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Patients with recurrent HCV benefit from triple therapy after liver transplant

Triple therapy was effective in a cohort of liver transplant recipients with recurrent hepatitis C, although adverse events were common in a recent study.

In a multicenter cohort study in France, researchers evaluated 37 patients with recurrent hepatitis C genotype 1 who underwent liver transplantation (LT) and received triple therapy with either boceprevir (n=18) or telaprevir (n=19) in addition to pegylated interferon and ribavirin, for a median of 41 weeks. The cohort included 18 patients who were treatment naive and five who had relapsed and 14 who had been nonresponsive during prior dual therapy after transplantation. Patients received calcineurin inhibitor (CNI) therapy with cyclosporine (n=22) or tacrolimus (n=15).

At 12 weeks of treatment, 89% of boceprevir and 58% of telaprevir recipients experienced complete virological response (P=.06), while end-of-treatment response was observed in 72% of evaluable boceprevir recipients and 40% of telaprevir recipients. Sustained virological response 12 weeks after treatment completion occurred in 71% of evaluable boceprevir patients and 20% of evaluable telaprevir recipients (P=.24).

Virologic breakthrough occurred in six patients, with a median delay of 35 weeks, and five participants were nonresponsive to treatment. Sixteen patients discontinued treatment early, including 11 because of failure and five because of adverse events. The most commonly observed event was anemia, which 34 patients experienced, including all boceprevir patients and 84% of the telaprevir group. Ten patients developed infection, and three died as a result.

“Our results cannot replace a targeted pharmacological study,” the researchers wrote. “They need to be confirmed, because interpatient variations in the potency of drug-drug interactions are a well-known phenomenon and we only treated a small number of patients. Nevertheless, our study confirmed that CNI-protease inhibitor interactions impacted the monitoring of patients, but could be managed.

“These very encouraging results, in terms of feasibility, represent an important step toward development in the near future of new protocols with novel antiviral drugs appropriate to the context of LT.”

Disclosure: See the study for a full list of relevant financial disclosures.