Does boceprevir really increase the risk of skin eruptions during antihepatitis C treatment?

Abstract

DEAR EDITOR, We read with great interest the article by Orrin et al. 1 recently published in the BJD. In that article, they described the U.K. experience with protease inhibitors, specifically the cutaneous side-effects seen with telaprevir and boceprevir combined with pegylated interferon plus ribavirin, for the treatment of patients with hepatitis C virus (HCV) genotype 1. In that study they concluded that the addition of telaprevir or boceprevir to a pegylated interferon/ribavirin regimen increased the risk of cutaneous adverse reactions, suggesting that this is a class effect with protease inhibitors.It is well known that the use of telaprevir increases the frequency and severity of skin eruptions. 2 However, we consider that this is not so clear in the case of boceprevir. Reviewing the literature, the two clinical trials that led to the approval of boceprevir, SPRINT-2 and RESPOND-2, showed contradictory results in relation to the increase of skin adverse events in patients who received triple therapy with boceprevir compared with pegylated interferon/ribavirin. 3-5 A meta-analysis published later concluded that a higher risk of skin eruptions was observed with boceprevir triple antiviral therapy than with dual therapy, both in treatment-naive patients and in treatment-experienced patients. 6 Based on our own experience, we performed a prospective study including 82 patients with HCV genotype 1, who received treatment with telaprevir (60 patients) or boceprevir (22 patients) in combination with pegylated interferon and ribavirin in daily clinical practice. The results obtained with the 60 patients in the telaprevir group are included in an article that has already been accepted for publication. 7 Regarding the 22 patients in the boceprevir group, five (23%) developed a drug-induced skin eruption. The onset time of the skin lesions ranged from 5 to 25 weeks after the introduction of boceprevir. In all cases, the clinical pattern was eczematous and the lesions were localized on the lower limbs, upper limbs and trunk. The severity of skin eruptions was mild, so they were treated with topical corticosteroids and resolved in a few days. Skin biopsy and discontinuation of triple antiviral treatment due to cutaneous side-effects were not required.Searching in the PubMed database, we found a few publications that described skin eruptions during boceprevir triple therapy in clinical practice. Recently, Kłujszo et al. 8 have published a study with 109 patients, of whom 33 received boceprevir triple therapy. Out of this cohort, 21% developed skin eruptions and the most frequent clinical pattern was eczematous dermatitis. None had to discontinue the antiviral treatment due to cutaneous side-effects.As we mentioned above, some studies 3 showed that the frequency of skin eruptions was similar when using pegylated interferon/ribavirin alone or in combination with boceprevir. Reviewing the literature, the frequency when using the dual therapy ranged from 34% 2 to 19% 9 depending on the series. Similar percentages were obser...

Cutaneous eruptions by new therapies against hepatitis C virus infection. Not as common as we presumed

“…It has not been proven that newer protease inhibitors such as boceprevir increase the risk of skin rashes, as Carrascosa et al . explain in their article . There is a new combination of drugs, Ombitasvir/Paritaprevir/Ritonavir and Dasabuvir (Viekirax ® and Exviera ® ) that is worth discussing, following our experience with a patient who had a generalized maculopapular rash (Fig.…”