Triple Therapy Treatment Outcomes in Patients with Chronic Hepatitis C at a Referral Center in South Florida

Abstract

Purpose: The goal of this study is to evaluate the efficacy and safety of triple therapy antiviral treatment for individuals with hepatitis C in a retrospective study at a South Florida referral center. Methods: Sixty genotype 1 (GT 1) individuals were included in this study (33 males, 27 females). Mean age was 52 years, with a range of 21 to 73, including 37% over the age of 60. Peginterferon alpha-2a/2b (PEG-IFN), ribavirin (RBV) and telaprevir/boceprevir were administered to each patient. Dosage was tailored to patient response. Total treatment duration ranged from 24 weeks to 48 weeks. Patients were monitored during treatment and up to six months post treatment. Results: Among 60 subjects, 47 (78%) achieved SVR (sustained virological response) 24 weeks after treatment completion. There is a strong correlation between lower BMI and early virological response. Relapse rate was 10%, and the overall discontinuation rate was 12%. Sixty-eight percent suffered from major depression, and 5% suffered from extreme psychiatric conditions. Fourteen percentexperienced retinopathy and ocular deficiencies, which subsided post treatment. Males were more susceptible to thrombocytopenia, while females were more susceptible to lymphocytopenia. One case resulted in idiopathic thrombocytopenic purpura, which prevented further treatment. Six (10%) patients had dermatological symptoms, including one case of cutaneous sarcoidosis. Overall, 11 (18%) patients were hospitalized through the course of triple therapy treatment, a majority of whom required blood transfusions. Conclusion: The side effects of triple therapy are substantial, and a decision to begin treatment must effectively weigh the risks versus the benefits. Lower BMI and early virological response are factors associated with improved treatment outcome. Proposed decrease of ribavirin dose due to anemia may cause relapse after ETR (end of treatment response). Despite improvements over PEG-IFN/RBV therapy, a more efficient and safer treatment option is urgently needed. Disclosure - Dr. Sornmayura - Speaking and Teaching: Merck Dr. Schiff - Consultant: Gilead, Merck; Scientific Advisory Board: Bristol Myers Squibb, Gilead, Vertex Pharmaceuticals; Grant/Research Support: Abbott, Anadys, Bristol Myers Squibb, Gilead, Merck, Medtronics, Novelos Therapetics, Orasure Technologies, Roche Molecular, Vertex Pharmaceuticals, Discovery Life Sciences, Beckman Coulter.Figure