Shorter treatment for hepatitis C virus may be possible with protease inhibitor

Key Points

Analysis of the hepatitis C virus (HCV) kinetics during treatment with protease inhibitor telaprevir shows a rapid viral decline, which could allow for shorter treatment, according to a study published online in Hepatology.

Chronic HCV infection has a worldwide prevalence of about 3%. Achieving a long-term sustained virologic response (SVR), defined as undetectable HCV RNA in serum 24 weeks after the end of treatment, is the most effective way to prevent disease progression. Currently, treatment outcome with pegylated interferon and ribavirin is correlated with HCV genotype and SVR is only achieved in half of HCV genotype 1 patients, the most prevalent genotype in western countries.

Researchers Jeremie Guedj, PhD, and Alan S. Perelson, PhD, from the Los Alamos National Laboratory in New Mexico, examined HCV viral decline during treatment with telaprevir.

The researchers found that the second-phase viral decline was associated with the effectiveness of treatment, and was about 4 times more rapid with telaprevir than interferon-based therapies. Also the viral kinetics were consistent across patients and dosing-group regimen and did not reveal variations as large between patients as when treated with the standard of care.

"We determined that, if resistance could be avoided and assuming full compliance to treatment, 7 to 10 weeks of treatment would be sufficient to clear HCV with telaprevir in 95% of patients," Guedj said. "This result may drive future clinical trials. However to attain SVR in 95% of treatment-compliant patients with a 10-week course of therapy will require treatments with 3 or more direct-acting antivirals including ribavirin. Clearly, at present there are no approved regimes that meet our criteria of high potency and a high enough barrier to resistance."

SOURCE

Guedj J, Perelson AS. Second phase HCV RNA decline during telaprevir based therapy increases with drug effectiveness: Implications for treatment. Hepatology. 2011;Mar 7 doi:10.1002/hep.24272 [Epub ahead of print].