A Small Percentage of Patients With Hepatitis C Receive Triple Therapy With Boceprevir or Telaprevir

Chen, Emerson Y.; Sclair, Seth N.; Czul, Frank; Apica, Betty; Dubin, Perry H.; Martin, Paul; Lee, William M.

doi:10.1016/j.cgh.2013.03.032

Cited by 26 publications

(19 citation statements)

References 22 publications

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“…Low treatment efficacy and poor tolerability contributed to infrequent treatment initiation in the dual-therapy era. Community-based data from Canada demonstrated that less than 1.1% of potentially treatment-eligible HCV patients initiated treatment in the early 2000 s. Studies of patients engaged in HCV care have demonstrated a higher frequency of treatment initiation, with dual-therapy era treatment initiation among ‘‘eligible’’ patients ranging from 19% (Charlebois et al, 2012; Chen et al, 2013) to 37% (Clark et al, 2012). Comorbid mental illnesses seem to influence HCV treatment initiation, as patient cohorts with high prevalence of mental illness and substance use disorders have reported lower HCV treatment initiation (Sockalingam et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Primary Care-Based Hepatitis C Treatment Outcomes With First-Generation Direct-Acting Agents

Woodrell

Weiss²,

Branch³

et al. 2015

Journal of Addiction Medicine

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Objectives Vulnerable, urban populations with a history of substance use disorders have a high prevalence of hepatitis C virus (HCV). Primary care-based treatment has been proposed to improve access to care. In this study, we present outcomes from our urban, primary care-based HCV treatment program in patients treated with telaprevir or boceprevir in combination with pegylated-interferon and ribavirin (‘‘triple therapy’’). Methods We collected data from 126 consecutive patients with genotype 1 HCV monoinfection seen in our treatment program (2011–2013). Among the 40 who initiated treatment, we analyzed factors associated with achieving a sustained viral response (SVR). Results During the study period, 40 patients initiated triple therapy (32%), 80% with recent or past substance use disorders. Patients initiating treatment were younger than untreated patients (P = 0.002), but otherwise did not differ demographically, or in the severity of their liver fibrosis (P >0.05). An SVR was achieved in 18 patients (45%) and was less likely in patients with recent or past substance use disorders or psychiatric illness (both P <0.01). Conclusions Nearly one third of patients initiated triple therapy with SVR rates comparable to other HCV treatment settings, despite a significant burden of mental illness and substance dependence. Our experience demonstrates that a primary care-based practice can successfully deliver HCV care to a vulnerable population. Additional interventions may be needed to improve outcomes in patients with recent or past substance use disorders or psychiatric illness.

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Section: Discussionmentioning

confidence: 99%

Primary Care-Based Hepatitis C Treatment Outcomes With First-Generation Direct-Acting Agents

Woodrell

Weiss²,

Branch³

et al. 2015

Journal of Addiction Medicine

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“…Previously, our group showed that 18.7 % of patients from two large academic centers in Dallas and Miami were initiated on treatment with triple therapy during the first 12 months following approval of boceprevir and telaprevir [2]. Here, we would like to share our results of patients treated with triple therapy beginning 6/1/2011 through 11/30/2012 from this Dallas–Miami cohort.…”

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confidence: 89%

Low SVR Rates in Clinical Practice for Treating Genotype 1 Chronic Hepatitis C with Protease Inhibitors Boceprevir and Telaprevir

et al. 2014

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“…From the 1 University of California, San Diego, La Jolla, CA; 2 Fundacion de Investigacion de Diego, Santurce, Puerto Rico; 3 Texas Liver Institute, San Antonio, TX; 4 Liver Institute of Virginia, Richmond, VA; 5 Hôpital Cochin, Paris, France; 6 Quality Medical Research, PLLC, Nashville, TN; 7 Gilead Sciences, Inc., Foster City, CA; 8 Inserm 1110, Universite de Strasbourg, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; and 9 Johns Hopkins University School of Medicine, Baltimore, MD.…”

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confidence: 99%

“…Moreover, no treatment options are currently available for patients with HCV infection who are ineligible for or intolerant of interferon. 3,4 Efforts to optimize outcomes of HCV treatment have focused on combinations of investigational direct-acting antiviral agents (DAAs) with unique mechanisms of action. Studies investigating DAA combinations have shown that SVR can be achieved with shorter treatment durations and in the absence of IFN.…”

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confidence: 99%

All-oral combination of ledipasvir, vedroprevir, tegobuvir, and ribavirin in treatment-naïve patients with genotype 1 HCV infection

et al. 2014

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This phase II trial assessed the efficacy and safety of a combination regimen of the nonstructural protein (NS)5A inhibitor ledipasvir (LDV), NS3 protease inhibitor vedroprevir (VDV), non-nucleoside NS5B inhibitor tegobuvir (TGV), and ribavirin (RBV) in treatment-na€ ıve patients with chronic hepatitis C virus (HCV) genotype 1 without cirrhosis. Patients were randomized 1:2 to LDV 30 mg once daily (QD; Arm 1; n 5 46) or LDV 90 mg QD (Arm 2; n 5 94); patients in both arms also received VDV 200 mg QD, TGV 30 mg twice-daily, and RBV 1,000-1,200 mg/day. Patients in Arm 2 with vRVR, defined as HCV RNA below the lower limit of quantification (LLOQ) from treatment weeks 2 to 10, were randomized 1:1 to stop treatment at 12 weeks or continue for 24 weeks. Sustained virologic response 12 weeks after treatment (SVR12) was higher in patients receiving 90 mg of LDV for 24 weeks (63%), compared with LDV 90 mg for 12 weeks (54%) and LDV 30 mg for 24 weeks (48%). In patients with very rapid virologic response (vRVR) in Arm 2, SVR12 was achieved by 68% and 81% of patients treated for 12 and 24 weeks, respectively. Virologic breakthrough was more common in patients with HCV genotype 1a and was associated with resistance-associated variants for all three direct-acting antiviral agents (DAAs); however, in all but 1 patient who relapsed, resistance-associated variants directed against only one or two of the DAAs were detected. The most common adverse events were fatigue, headache, nausea, rash, and diarrhea. Conclusion: In patients with HCV genotype 1, an interferon-free regimen containing LDV/VDV/TGV/RBV was well tolerated and led to SVR12 in up to 63% of patients. LDV 90 mg is currently being investigated in combination with the nucleotide polymerase inhibitor, sofosbuvir. (HEPATOLOGY 2014;60:56-64)

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A Small Percentage of Patients With Hepatitis C Receive Triple Therapy With Boceprevir or Telaprevir

Cited by 26 publications

References 22 publications

Primary Care-Based Hepatitis C Treatment Outcomes With First-Generation Direct-Acting Agents

Primary Care-Based Hepatitis C Treatment Outcomes With First-Generation Direct-Acting Agents

Low SVR Rates in Clinical Practice for Treating Genotype 1 Chronic Hepatitis C with Protease Inhibitors Boceprevir and Telaprevir

All-oral combination of ledipasvir, vedroprevir, tegobuvir, and ribavirin in treatment-naïve patients with genotype 1 HCV infection

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