Page 49 - The Flying Publisher Guide to Hepatitis C Treatment

Antiviral therapy in non-responders, relapsers and special populations | 49

and, to a lesser extent, prior non-responders in phase III trials. A
detailed presentation of the newly aproved direct-acting
antivirals (DAAs) is given in chapter 4.
Prove-3 trial evaluated triple-combination therapy with
telaprevir in treatment-experienced patients (~60% non-
responders and ~40% relapsers) (McHutchison 2010). Patients
were randomized on four treatment arms in order to assess the
impact of different durations of triple therapy, different total
treatment duration and the importance of RBV for this difficult-
to-treat population. Prior relapsers treated with 24 weeks of
triple therapy followed by 24 weeks of PegIFN/RBV (total
duration of therapy 48 weeks) had a SVR rate of 76%, while prior
non-responders had lower rates of SVR (~40% ).
RESPOND-2 evaluated triple therapy combination with
boceprevir in non-responders and relapsers (Bacon 2011). The
results indicate that 75% of prior relapsers and 52% of prior non-
responders treated with a fixed triple therapy boceprevir
regimen achieved SVR. In the response-guided arm, SVR was 69%
in prior relapsers and 40% in prior non-responders.
Curent available data clearly show that that triple therapies
including a protease inhibitor provide higher chance of SVR
for relapsers and non-responders. The benefits of these novel
treatment regimens for each individual patient must be weighed
against the side effects, costs and potential of developing viral
resistance.

Practical approach to retreatment
When deciding retreatment of previous non-sustained
responders to standard therapy, the following practical issues
should be considered:
– Patient’s motivation for another course of therapy. Lower
likelihood of SVR in treatment-experienced patients, side
effects, poor QoL should be discussed with the patient;
– Severity of liver disease (clinical, biochemical,
histological). Patients with minimal-to-moderate fibrosis