Effectiveness and safety of first-generation protease inhibitors in clinical practice: Hepatitis C virus patients with advanced fibrosis

Abstract

Aim: To evaluates the effectiveness and safety of the first generation, NS3/4A protease inhibitors (PIs) in clinical practice against chronic C virus, especially in patients with advanced fibrosis.

Methods: Prospective study and non-experimental analysis of a multicentre cohort of 38 Spanish hospitals that includes patients with chronic hepatitis C genotype 1, treatment-naïve (TN) or treatment-experienced (TE), who underwent triple therapy with the first generation NS3/4A protease inhibitors, boceprevir (BOC) and telaprevir (TVR), in combination with pegylated interferon and ribavirin. The patients were treatment in routine practice settings. Data on the study population and on adverse clinical and virologic effects were compiled during the treatment period and during follow up.

Results: One thousand and fifty seven patients were included, 405 (38%) were treated with BOC and 652 (62%) with TVR. Of this total, 30% (n = 319) were TN and the remaining were TE: 28% (n = 298) relapsers, 12% (n = 123) partial responders (PR), 25% (n = 260) null-responders (NR) and for 5% (n = 57) with prior response unknown. The rate of sustained virologic response (SVR) by intention-to-treatment (ITT) was greater in those treated with TVR (65%) than in those treated with BOC (52%) (P < 0.0001), whereas by modified intention-to-treatment (mITT) no were found significant differences. By degree of fibrosis, 56% of patients were F4 and the highest SVR rates were recorded in the non-F4 patients, both TN and TE. In the analysis by groups, the TN patients treated with TVR by ITT showed a higher SVR (P = 0.005). However, by mITT there were no significant differences between BOC and TVR. In the multivariate analysis by mITT, the significant SVR factors were relapsers, IL28B CC and non-F4; the type of treatment (BOC or TVR) was not significant. The lowest SVR values were presented by the F4-NR patients, treated with BOC (46%) or with TVR (45%). 28% of the patients interrupted the treatment, mainly by non-viral response (51%): this outcome was more frequent in the TE than in the TN patients (57% vs 40%, P = 0.01). With respect to severe haematological disorders, neutropaenia was more likely to affect the patients treated with BOC (33% vs 20%, P ≤ 0.0001), and thrombocytopaenia and anaemia, the F4 patients (P = 0.000, P = 0.025, respectively).

Conclusion: In a real clinical practice setting with a high proportion of patients with advanced fibrosis, effectiveness of first-generation PIs was high except for NR patients, with similar SVR rates being achieved by BOC and TVR.

Trial registration: ClinicalTrials.gov NCT02004379.

Keywords: Advanced fibrosis; Boceprevir; First-generation protease inhibitors; Hepatitis C; Telaprevir.

Figures

Figure 1

Study ALHAMBRA cohort. Cohort global of patients included in the study (n = 1057) according to treatment PIs (BOC or TVR) by ITT and mITT and stage of fibrosis (non-F4 and F4). PIs: Protease inhibitors; BOC: Boceprevir; TVR: Telaprevir; ITT: Intention-to-treatment; mITT: Modified intention-to-treatment.

Figure 2

SVRw12 intention-to-treatment and modified-intention-to-treatment. SVRw12 rates in ITT (n = 1057) (A), and mITT (n = 952) (B) groups. BOC: Boceprevir; TVR: Telaprevir; ITT: Intention-to-treatment; mITT: Modified intention-to-treatment; TN: Treatment-naïve patients; R: Relapsers; PR: Partial responder; NR: Null responder.

Figure 3

SVRw12 according to stage of fibrosis. Response to treatment according to stage of fibrosis (Non-F4 vs F4) in all patients (A), in the group of patients treated with BOC (B) and in the group of patients treated with TVR (C). BOC: Boceprevir; TVR: Telaprevir; HCV: Hepatitis C virus.