Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 28, 2015; 7(9): 1287-1296
Published online May 28, 2015. doi: 10.4254/wjh.v7.i9.1287
Management of telaprevir-based triple therapy for hepatitis C virus recurrence post liver transplant
Kerstin Herzer, Angela Papadopoulos-Köhn, Anne Achterfeld, Ali Canbay, Katja Piras-Straub, Andreas Paul, Andreas Walker, Jörg Timm, Guido Gerken
Kerstin Herzer, Angela Papadopoulos-Köhn, Anne Achterfeld, Ali Canbay, Katja Piras-Straub, Guido Gerken, Department of Gastroenterology and Hepatology, University Hospital Essen, 45122 Essen, Germany
Kerstin Herzer, Andreas Paul, Department of General - Visceral - and Transplantation Surgery, University Hospital Essen, 45122 Essen, Germany
Andreas Walker, Jörg Timm, Institute for Virology, Heinrich Heine University, 40225 Düsseldorf, Germany
Author contributions: Herzer K contributed to research design, performance of the research, data analysis and writing of the paper; Papadopoulos-Köhn A contributed to research design, performance of the research and data analysis; Piras-Straub K contributed to data analysis; Achterfeld A contributed to performance of the research; Canbay A contributed to performance of the research and writing of the paper; Paul A contributed to writing of the paper; Walker A contributed to performance of the research; Timm J contributed to performance of the research, data analysis; Gerken G contributed to writing of the paper.
Supported by The Federal funds for the National Reference Centre for Hepatitis C, Herzer K has received grant support from Astellas, Biotest and Novartis and been a consultant/speaker for AbbVie, Biotest, Bristol-Myers Squibb, Gilead Sciences, Janssen Pharmaceuticals, Novartis, and Roche; Gerken G has been a consultant/speaker for AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen Pharmaceuticals and Roche.
Ethics approval: The study was reviewed and approved by the University Hospital Essen Institutional Review Board (IRB).
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: None.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at email address: kerstin.herzer@uk-essen.de. The presented data are annonymized without risk of identification.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kerstin Herzer, MD, Associate Professor, Department of Gastroenterology and Hepatology, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany. kerstin.herzer@uk-essen.de
Telephone: +49-201-7235147 Fax: +49-201-7236926
Received: September 15, 2014
Peer-review started: September 20, 2014
First decision: November 14, 2014
Revised: February 27, 2015
Accepted: March 30, 2015
Article in press: April 2, 2015
Published online: May 28, 2015
Processing time: 246 Days and 21.3 Hours
Abstract

AIM: To characterize management of telaprevir (TVR)-based triple therapy of hepatitis C virus (HCV) reinfection after liver transplantation (LT).

METHODS: We retrospectively analyzed safety and efficacy of telaprevir - based triple therapy in a single center cohort of 19 patients with HCV genotype (GT) 1 recurrence after LT, with respect to factors possibly predicting sustained viral response (SVR) or non-SVR. All patients were treated with TVR, pegylated (PEG) and ribavirine (RBV) for 12 wk followed by a dual phase with PEG/RBV for 12 wk in 7 patients and for 36 wk in 5 patients.

RESULTS: In total 11/19 (58%) of patients achieved a sustained response. All (11/11) SVR patients showed a rapid viral response at treatment weeks 4 and 11/14 rapid virological response (RVR) patients achieved SVR. Notably, all (7/7) patients who completed 48 wk of therapy and 80% (4/5) patients who completed 24 wk of therapy achieved SVR24. Treatment failure was significantly (P > 0.049) more frequent in GT1a infection (5/7) compared to GT1b (3/12) infection and was associated with emergence of resistance-associated mutations in the NS3 protease domain. Bilirubin level at baseline is also related to SVR (P > 0.030). None of the patients had to discontinue treatment due to side effects.

CONCLUSION: RVR, GT and bilirubin are clearly related to achievement of SVR. Providing a thorough patient selection and monitoring, a full course of TVR-based triple therapy in LT patients is feasible and achieves high SVR rates.

Keywords: Liver transplantation; Telaprevir; Hepatitis C virus recurrence; Predictors; Hepatitis C virus therapy

Core tip: Experiences with telaprevir-based triple therapy in 19 patients with hepatitis C virus recurrence after liver transplantation are analysed and described in detail. We observed a exceptionally high sustained viral response rate and analyzed clinicopathological factors which might contribute to predict which patients rather benefit from this therapy and which do not. While the new generation directly acting antivirals start to be available in some countries, many parts of the world will not have the privilege of these therapeutic options for a long time. Therefore we are eager to share our experiences with telaprevir in liver transplantation patients with the international hepatologist community.