Early virological assessment during telaprevir- or boceprevir-based triple therapy in hepatitis C cirrhotic patients who failed a previous interferon based regimen – The ANRS CO20-CUPIC study
Résumé
BACKGROUND AND OBJECTIVE:
To assess within the ANRS CO20-CUPIC cohort whether the viral load (VL) at week 2/week 6 for telaprevir/boceprevir-based triple therapy, respectively, was predictive of sustained virological response (SVR) in patients with hepatitis C virus (HCV) infection and to study the relevance of this measurement to early diagnose drug resistance.
METHODS:
Observational study of HCV genotype 1 patients with compensated cirrhosis (Child-Pugh A), non-responders to a prior course of interferon (IFN)-based therapy and who started triple therapy. Patients received either 12 weeks of telaprevir in combination with PEG-IFN/ribavirin (RBV), then 36 weeks of PEG-IFN/RBV, or 4 weeks of PEG-IFN/RBV, then 44 weeks of PEG-IFN/RBV and boceprevir.
RESULTS:
A total of 262 patients were analyzed. For telaprevir-treated patients, 28% had undetectable VL at W2 of whom 81% achieved SVR12 whereas 67% had undetectable VL at W4 of whom 67% achieved SVR12. For boceprevir-treated patients 20% had undetectable VL at W6 and 86% of them achieved SVR12 whereas 36% had undetectable VL at W8 among whom 73% achieved SVR12. Five telaprevir-treated patients had a VL increase between W2 and W4 after a decrease between D0 and W2. Four of them did not achieve SVR12. Similarly, six boceprevir-treated patients had a VL increase between W6 and W8 after a decrease between D0 and W6. Five did not reach SVR12.
CONCLUSIONS:
The assessment of HCV RNA level after two weeks of triple therapy in cirrhotic non-responder patients is a good predictor of SVR. This assessment was useful to do an early diagnosis of viral breakthrough.
Mots clés
Antiviral Agents / therapeutic use
Drug Therapy
Combination
Female
Hepacivirus / genetics
Hepacivirus / metabolism
Hepatitis C
Chronic / drug therapy
Humans
Interferon-alpha / therapeutic use
Liver Cirrhosis / drug therapy
Liver Cirrhosis / virology Male
Middle Aged
Oligopeptides / therapeutic use
Polyethylene Glycols / therapeutic use
Proline / analogs & derivatives
Proline / therapeutic use
Prospective Studies
Protease Inhibitors / therapeutic use
RNA / metabolism
Recombinant Proteins / therapeutic use
Ribavirin / therapeutic use
Viral Load