Boceprevir in liver transplant recipients.

Abstract

BACKGROUND:

There has been increasing interest in using protease inhibitors with pegylated interferon and ribavirin to treat recurrent hepatitis C (HCV) disease in liver transplant recipients.

METHODS:

We retrospectively evaluated the safety and efficacy in liver transplant recipients treated for recurrent hepatitis C genotype 1 with the combination of peginterferon, ribavirin and boceprevir.

RESULTS:

Twenty liver transplant recipients were treated for recurrent hepatitis C. Baseline alanine aminotransferase, total bilirubin and HCV RNA values (± SD) were 67.5 (±50.9) mg/dl, 1.78 (±1.99) U/L, and 16 955 510 (±21 620 675) IU/ml. Anaemia was a common adverse event requiring epoetin in 16 of 20 recipients and ribavirin dose reductions in 17 of 20 recipients. One-third of recipients required a blood transfusion. Filgrastim was used in 11 of 20 patients (55%) and eltrombopag in two of 20 recipients (10%) over the course of treatment. Serum creatinine level increased significantly from a baseline value of 1.33 mg/dl to 1.59 mg/dl at week 20 of boceprevir (P < 0.005). The overall sustained viral response (SVR) was 50%. Of the 14 patients who had a viral load less than 1000 IU/ml at week 4 of boceprevir, the SVR was 71%. The SVR was 83% of the 11 patients who had undetectable viral levels at week 4 of boceprevir.

CONCLUSIONS:

Antiviral therapy utilizing boceprevir in liver transplant recipients requires close monitoring. Anaemia and neutropenia were common requiring growth factors in most recipients. On-treatment viral responses appear promising but long-term data are needed.

• Authors: Sammy Saab, Vignan Manne, Sherona Bau, Justin A Reynolds, Ruby Allen, Leonard Goldstein, Francisco Durazo, Mohammed El-Kabany, Steven Han, Ronald W Busuttil
• Journal: Liver international : official journal of the International Association for the Study of the Liver (Liver Int) Vol. 35 Issue 1 Pg. 192-7 (Jan 2015) ISSN: 1478-3231 [Electronic] United States
• PMID: 24673728 (Publication Type: Journal Article)
• Copyright: © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Interferon-alpha
• Protease Inhibitors
• RNA, Viral
• Recombinant Proteins
• Polyethylene Glycols
• Ribavirin
• N-(3-amino-1-(cyclobutylmethyl)-2,3-dioxopropyl)-3-(2-((((1,1-dimethylethyl)amino)carbonyl)amino)-3,3-dimethyl-1-oxobutyl)-6,6-dimethyl-3-azabicyclo(3.1.0)hexan-2-carboxamide
• Proline
• Creatinine
• peginterferon alfa-2a

Topics

• Adult
• Aged
• Analysis of Variance
• Creatinine (blood)
• Drug Monitoring (methods)
• Female
• Hepatitis C (drug therapy)
• Humans
• Interferon-alpha (therapeutic use)
• Liver Transplantation
• Male
• Middle Aged
• Polyethylene Glycols (therapeutic use)
• Proline (analogs & derivatives, therapeutic use)
• Protease Inhibitors (therapeutic use)
• RNA, Viral (blood)
• Recombinant Proteins (therapeutic use)
• Recurrence
• Retrospective Studies
• Ribavirin (therapeutic use)
• Transplant Recipients (statistics & numerical data)