Hi desrt, this was on the expert commentary part... Hope all is well.
Use of Telaprevir in Genotype 2 or 3 HCV—Not Likely
Mitchell L. Shiffman, MD
Posting Date: December 13, 2011
Director, Liver Institute of Virginia
Bon Secours Virginia Health System
Richmond and Newport News, Virginia
Telaprevir works very effectively against hepatitis C virus (HCV) genotype 1 infection, and a wealth of data support this fact.[1-5] By contrast, there are very few data about the efficacy of telaprevir in HCV genotypes 2 and 3, particularly in combination with peginterferon/ribavirin.
To shed light on this issue, Foster and colleagues conducted a randomized phase IIa study in patients chronically infected with HCV genotype 2 or 3 to determine whether the addition of telaprevir to peginterferon/ribavirin enhanced the rates of sustained virologic response (SVR). In total, 26 patients with HCV genotype 2 (23 were treated) and 26 patients with HCV genotype 3 infection were randomly assigned to receive 15 days of telaprevir, telaprevir plus peginterferon/ribavirin, or peginterferon/ribavirin, all followed by peginterferon/ribavirin for 22-24 weeks.
Unfortunately, the results of this study were somewhat disappointing. There was additive efficacy with telaprevir in patients with HCV genotype 2 infection. For example, the kinetics of virologic suppression occurred earlier and was deeper with the addition of telaprevir to peginterferon/ribavirin vs peginterferon/ribavirin alone (eg, median HCV RNA change at Day 3: -4.03 vs -2.04 log10 IU/mL; median HCV RNA change at Day 15: -5.51 vs -4.83 log10 IU/mL). All 5 patients who received telaprevir/peginterferon/ribavirin triple therapy attained SVR compared with 8 of 9 patients assigned to peginterferon/ribavirin control (100% vs 89%). One must recognize, however, that infection with HCV genotype 2 has the highest cure rate of all HCV genotypes when treated with peginterferon/ribavirin. Thus, despite having some antiviral activity against this type of HCV, the addition of telaprevir to peginterferon/ribavirin really has very little impact on overall SVR in this patient population.
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