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Comparison of Hepatitis C virus protease inhibitors in the USA

The most recent issue of the Alimentary Pharmacology & Therapeutics compares the effectiveness of the hepatitis C virus protease inhibitors boceprevir vs telaprevir in a large cohort in the USA.

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Limited data exist on the effectiveness of boceprevir and telaprevir in routine practice.

Dr Backus and colleagues from California, USA assessed the comparative effectiveness of boceprevir and telaprevir regimens.

In this observational, intent-to-treat cohort analysis of hepatitis C genotype 1-infected veterans initiated on peginterferon/ribavirin and boceprevir or telaprevir, the researchers determined sustained virological response, treatment discontinuation rates and adverse hematological events.

Inverse probability-of-treatment weighting was used to estimate the effect of one drug over the other, with matched pairs and unweighted logistic regression on the entire cohort for comparison.

Of 835 veterans, sustained virological response occurred in 50% and 52% receiving boceprevir- and telaprevir-based treatment, respectively.

The research team found no significant differences occurred among cirrhotics, null responders, partial responders and relapsers.

The researchers noted that early discontinuation rates for boceprevir and telaprevir, respectively, were 31% and 28% by week 24, and 54% and 45% by 48 weeks.

The team found that the choice of telaprevir over boceprevir was significantly associated with SVR in multivariate models.

Rates of hematological adverse events in boceprevir- and telaprevir-treated patients were 59% vs 51% with anemia, 41% vs 48% with thrombocytopenia, 41% vs 27% with neutropenia.

Dr Backus' team comments, "Sustained virological response was more likely with telaprevir-based regimens compared with boceprevir-based regimens in routine medical practice, after accounting for patient differences."

"Early discontinuation and haematological events, however, were similar."

Aliment Pharmacol Ther 2014: 39(1): 93–103
09 December 2013

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