A SHORT COURSE OF TRIPLE TELAPREVIR-BASED ANTIVIRAL THERAPY: THE PRINCIPLES OF PATIENTS SELECTION

Abstract

Background: The beginning of a new era of direct acting antivirals sets up its own rules, that is, to achieve the highest efficacy with the shortest duration of treatment. It is assumed that the use of the first generation of direct acting antivirals, similarly to interferon-free regimens, would allow for personalization of approaches to their prescriptions.Aim: To identify the most important parameters that can predict the greatest efficacy of triple antiviral therapy of 12 week duration in patients with chronic hepatitis C genotype 1.Materials and methods: The study included 204 patients with chronic hepatitis C virus (HCV) genotype 1 at an early stage of liver disease (METAVIR score F0-F2), who were either treatment-naive or had a history of relapse after standard of care antiviral therapy. In addition to routine work-up, all patients were screened for IL28B polymorphism; in the course of the treatment viral kinetics was assessed by an ultrasensitive polymerase chain reaction (PCR) (with lower limit of quantification of 12 IU/ml). Duration of the triple therapy (pegylated interferon-α2a, ribavirin and telaprevir) was reduced to 12 weeks if a rapid virological response was achieved; otherwise the patients continued their treatment in according with guidelines. Results: A complete rapid virological response was achieved in 174 patients (81.6%), in whom the duration of triple therapy was 12 weeks. According to the protocol, 25 patients with a partial rapid virological response continued their standard antiviral therapy for 12 weeks more. In those who achieved a rapid virological response, there was an association between IL28B-CC genotype at rs12979860 and maintenance of zero viremia at 12 weeks after termination of antiviral therapy (r = 0.38, p < 0.001). In all such patients there was a stable virological response at 12 weeks of the follow-up. Monitoring of viral load after 14 days of antiviral treatment was not predictive of its success. The preliminary results of a shortened (12 week) course of triple telaprevir-based viral therapy allowed to identify the most significant parameters of 100% efficacy, i.e., absence of the virus in blood at 12 weeks after termination of antiviral therapy. Conclusion: A 12 week course of triple telaprevir-based combination therapy is an optimal regimen for achievement of a stable virological response after 12 weeks of the follow-up in treatment-naïve patients with HCV genotype 1 or with a relapse after previous conventional antiviral treatment, who have IL28B – CC polymorphism, are at an early stage of liver disease and who achieve a rapid complete virological response confirmed by a highly sensitive PCR.

Keywords

• chronic hepatitis c
• short course of antiviral therapy
• telaprevir
• il28b
• sustained virological response