Of those who deferred and then started triple therapy, more than 30% were prior relapsers, while the majority of patients who deferred were treatment-naïve. However, the authors add, there was no difference in HCV RNA viral load, genotype 1 subtypes, or IL28B genotyping.

Twenty-one percent (19 patients) of those treated with triple therapy discontinued within 12 weeks of therapy—15% due to adverse events. Other reasons included nonadherence and nonresponse to DAA therapy.

The authors observed that the combined treatment rate of 18.8% was “nearly identical to the reported treatment rates during the dual therapy era.” They commented, “The disappointingly low use of the new therapies . . . suggests that several concerns are at play: the continued requirement of IFN, the safety profile, the low predicted response rates in prior nonresponders, coupled with the suggestion of further major improvements, such as IFN-free therapies, likely colored the thinking of physicians and patients alike in this setting.”


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Conclusion

Several current agents under investigation are second-generation HCV NS3/N4A oral protease inhibitors, HCV NS5A and NS5B inhibitors, and iIFN-sparing regimens5 The authors state that they expect that these new agents, once approved, “will be applied in the treatment of HCV-infected patients and that they will have more potent efficacy and less adverse events.”

References

1. World Health Organization. Hepatitis C: Fact sheet N°164. (July, 2013) Available at: http://www.who.int/mediacentre/factsheets/fs164/en/. Accessed: August 7, 2013.

2. Poordad F, Dieterich D. Treating hepatitis C: current standard of care and emerging direct-acting antiviral agents. J Viral Hepat. 2012;19(7):449-464.

3. Chan J. Treatment of chronic hepatitis C: The new standard of care for the future.

4. Chen EY, Sclair SN, Czul F, et al. A small percentage of patients with hepatitis C receive triple therapy with boceprevir or telaprevir. Clin Gastroenterol Hepatol. 2013;11(8):1014-1020.e2.

5. Kanda T, Yokosuka O, Omata M. Treatment of hepatitis C virus infection in the future. Clin Transl Med. 2013;2(1):9.

6. Formulary. August 1, 2011. Available at: http://formularyjournal.modernmedicine.com/formulary-journal/news/clinical/clinical-pharmacology/treatment-chronic-hepatitis-c-new-standard-car. Accessed: August 7, 2013.

7. Pol S, Ghalib RH, Rustgi VK, et al. Daclatasvir for previously untreated chronic hepatitis C genotype-1 infection: a randomised, parallel-group, double-blind, placebo-controlled, dose-finding, phase 2a trial. Lancet Infect Dis. 2012;12(9):671-677.