Drug & Device Development

Telaprevir, boceprevir offer similar efficacy for most patients with HCV 1

Last Updated: 2012-10-25 15:05:17 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - For most patients with hepatitis C virus (HCV) 1, telaprevir and boceprevir offer similar efficacy, researchers say.

"Based on our findings, I would feel that for the majority of patients there is no difference in efficacy between the two agents and the choice should come down to patient and physician preference with perhaps some consideration being given to cost if there are no pressing clinical reasons why one would choose a particular agent over another," Dr. Jennifer A. Kiernan from St. James Hospital, Dublin, Ireland, told Reuters Health.

She added, "For patients who have experienced a previous treatment relapse, our research would suggest that telaprevir would be a better choice."

As there are no head-to-head comparison trials so far, Dr. Kiernan and colleagues used a Bayesian mixed treatment comparison model to explore the relative differences in efficacy between boceprevir and telaprevir when used as a third agent (with pegylated interferon and ribavirin) in HCV genotype 1 treatment.

Their review online October 16 in Clinical Infectious Diseases included six studies related to treatment-na�ve patients and four studies related to treatment-experienced patients.

Among treatment-na�ve patients, adding boceprevir or telaprevir to the backbone therapy of interferon and ribavirin significantly improved efficacy, and there was insufficient evidence to detect a difference between the two drugs.

Results were similar in pretreated patients, but in the subset of patients who had a prior treatment relapse (n=841) there was a significant difference in efficacy favoring telaprevir.

Relapse rates did not differ between telaprevir and boceprevir for treatment-na�ve patients, but among patients with prior treatment, those treated with telaprevir had a lower relative rate of relapse compared with boceprevir treatment (although this difference fell just short of statistical significance).

"The optimum approach to this question would be a randomized controlled non-inferiority head-to-head trial," Dr. Kiernan said. "However, there are none planned. Therefore, this analysis provides useful estimates of relative efficacy."

"In Ireland, we are in the process of developing a national treatment outcomes registry to study the treatment outcomes of patients commenced on HCV protease inhibitor therapy," Dr. Kiernan added. "We hope that this will provide additional effectiveness data on how these agents perform in a real-world clinic-based environment."

SOURCE: http://bit.ly/S9ocxh

Clin Infect Dis 2012.