Telaprevir May Not Be Optimal Hepatitis C Treatment Post-Liver Transplant

Direct acting antiviral drugs may increase adverse events after liver transplantation.

A recent analysis concludes that patients with hepatitis C graft may have better options for standard therapy than telaprevir.

The study was conducted by Fritz Klein, of the Department of General, Visceral, and Transplantation Surgery at Charity Campus Virchow in Berlin, Germany, and colleagues, and was published in the journal Hepatitis Research and Treatment.

According to the researchers, “Hepatitis C Virus (HCV) recurrence after orthotopic liver transplantation (OLT) is the major cause of graft failure and death in HCV recipients.”

In 2011, with the introduction of NS3/4 protease inhibitors (PI) boceprevir (BOC) and telaprevir (TVR), the chance for patients to reach a sustained virological response (SVR) increased drastically.

“However, this first success of triple therapy was accompanied by a distinct increase of treatment-related serious adverse effects (SAE),” the researchers wrote.

More recently, HCV therapies have improved through the use of directly acting antivirals (DAA), among other treatments. The researchers say that the rapid development has led to a scarcity of studies on the long-term results from PI treatment.

Their goal was to investigate the results after one year of TVR, pegylated interferon (PegIFN) and ribavirin (RBV) triple therapy. This retrospective analysis included “12 genotype 1 infected liver graft recipients with HCV who underwent TVR-based antiviral triple therapy.”

Of the 12 participants, 58% (7) achieved an SVR, and all 7 maintained the SVR at a 2-year follow up. Adverse events affected the majority (91%) of participants.

Given the results, the researchers say, “In the context of the rapid developments in HCV treatment options in the last years, the clinical relevance of first generation PIs has…to be considered as rather negligible nowadays.”

They add that antiviral agents, including sofosbuvir, daclatasvir, simeprevir, and others, have fundamentally changed HCV therapy. Unfortunately, the newer antivirals are not always available due to economic burdens.

“Long-term results of PI therapy efficacy as well as the emergence of resistance thus need to be continuously analyzed in order to allow an optimal and evidence-based HCV treatment also in health care systems with limited access to recent achievements of HCV therapy,” the researchers concluded.