Boceprevir or Telaprevir?

[Missy114]

Hi everyone! I haven't been on here in a long time, but I am considering starting treatment now and I have a question.  First of all, my doctor recommended Boceprevir over Telaprevir because she says she "thinks" Boceprevir is more effective and reduces Tx time more than Telaprevir does. I know there are a lot of very knowledgable people on here that I can trust so I was wondering what you thought about that.  I honestly have not spent a lot of time researching this topic. It does seem as though Telaprevir is more popular for whatever reason though.

Anyways, quick background on me: I was diagnosed 2 years ago with genotype 1a.  I've probably had the virus for 7-8 years from IV drug use.  I haven't had any labs done in about a year or so, but my VL has always been extremely low, so low once that it was undetectable. The highest it has been is a little over 13,000.  I had a biopsy about a year and a half ago (when I was first considereing Tx) which came back great. No fibrosis.  Because of that I decided to wait for the new meds to come out.

[pooh55811]

They both have to be taken every 8 hours (leeway 7-9 hours).

http://www.drugs.com/mtm/boceprevir.html

http://www.drugs.com/incivek.html

So either way, you will be taking the PI every 8 hours regardless of which one it is. This is a must. They have very short half lives so the blood level drops and is not as effective if too much time passes between doses. If you do not take it properly and too much time passes between doses, you can get resistant strains of the virus and place your entire treatment in jeopardy.

[Mustlovedogs99]

I have heard that one of the inhibitors HAS to be taken EVERY 8 hours on the dot or the patient may develop resistant strains to any tx... is that true?  I am also on Webmd and one of the doctors that responses to the page has a youtube video about tx and she mentioned that.  Any thoughts?

[Missy114]

Thank you everyone for all the info. It has really helped. I might try it without the PI and just do the victrelis if needed. Still thinking about if I even want to treat now. I am pretty busy, but then again, I'll probably always be pretty busy, so I don't know if there will ever be a "good" time to go on tx. Anyways, thanks again. Still have a lot to think about, but you have all helped.

[nowhine]

A lot of good information has been provided. The studies lumped all geno 1's without consideration of 1a or 1b. 1b's are responding much better than 1'a to protease inhibitors. Also nothing is mentioned of INF response with regard to IL28B markers- CC, CT, or TT. I would agree with desrt, "no brainer", a 4 week lead in with INF/Riba to determine your initial response. If RVR add Vic.- if you decide to treat now.

Also agree with willbb, that finally mentioned the option of waiting, since you are young and have little liver damage. The INF/Riba tx is harsh for many. I'm sure you know, there are many, many, trials currently ongoing without INF. In addition, if you have a poor response in the lead in phase of INF/Riba it makes little since to add the protease, particuIarly if you are a 1a. Another thing to conisider-many of the new DAA combo trials are using protease and you may not be able to re-treat with a protease, for some period of time still unknown, as resistant mutations are present.  It appears you have the option of waiting. The 3x tx will still be available if the new DAA combos prove to be a failure. Best of luck, God bless.

[willbb]

http://www.ncbi.nlm.nih.gov/pubmed/18508296

CONCLUSION:  Both 24 and 48 weeks of therapy can achieve high SVR rates (>96%) in HCV-1 patients with low viral loads and an RVR.




http://www.medscape.com/viewarticle/708930_4

The majority of studies that have measured RVR have done so using the lower limit of quantification of 50 IU/ml. To use a more stringent cutoff would likely change the predictive values. This needs to be borne in mind when trying to compare across studies. Table 1 summarizes several genotype 1 studies where RVR was assessed in Peg IFN alfa 2a and alfa 2b. The overall predictability of SVR when RVR is achieved ranges from 72.5% to 100%.  When shortening therapy to 24 weeks in RVR patients, the PPV ranges from 74.2% to 88.9%, whereas PPV with 48 weeks ranges from 72.5% to 100%.




http://www.intmedpress.com/serveFile.cfm?sUID=246a4a78-2a19-4926-a77e-3011cf5e450c

In this study ...it basically says in table 1 about 3/4 of the way down the page that if there is low vral load and an RVR there is basically no difference in success rates 24 weeks vs. 48.  

Best..
Will

[willbb]

Hi missy...As desrt and I have said and cando has copied  the" Predict" study..

You are in an excellent position to  start therapy using just PEG/RIBA and if at 4 weeks you are UND.(RVR) then if in fact you have low VL (less than 400K) with no liver damage ..your chances of success are approx.  90% doing jut 24 weeks  by the data from studies(I will post them when I have more time)

At worst ..if you don't RVR you can then add Vic at that time(in line with what your doctor has suggested) to the mix(which is prescribed after 4 weeks anyway) and if UND at week 8(considered an RVR) then you still have about the same chance of success ..and the total time  treating would be 28 weeks.

As desrt ..so succinctly put it above...just about a no brainer.

There is anemia effects with approx.45 - 50 % of patients on both Inci. and Vic  and studies showed somewhat more severe for those on Vic(also what we see on the forum) in.(likely due to the longer time taking it),however this may be alleviated in most by slight Riba reduction and /or introduction of the growth factor "procrit..

Good luck..
Will