We read with great interest the article by Pascale et al., reporting a man with chronic hepatitis C virus (HCV) genotype 1b infection who relapsed after telaprevir-based triple therapy and achieved sustained virologic response (SVR) with a subsequent 48-week course of dual therapy (peginterferon alfa/ribavirin). We think the definition of failure to respond to telaprevir-based triple therapy seems not appropriate. This patient received telaprevir, peginterferon alfa-2a, and ribavirin for only 12 weeks in the phase 2 study. The recommendation of the American Association for the Study of Liver Diseases (AASLD) guidelines for the therapy for genotype 1 chronic HCV infection is the use of telaprevir in combination with dual therapy for 12 weeks followed by an additional 12 weeks (for patients without cirrhosis and with extended rapid virologic response [eRVR]: undetectable HCV RNA level at weeks 4 and 12) or 36 weeks (for patients with cirrhosis or without eRVR, or recommended to stop the therapy: HCV RNA level is >1,000 IU/mL at treatment weeks 4 or 12 and/or detectable at treatment week 24) of dual therapy. For genotype 1-naïve patients with RVR, high SVR rates have been reported previously by 24 weeks and 48 weeks dual therapy in our randomized trial (89% and 100%, respectively) and by Jensen et al. (89% and 91%, respectively). The SVR rate was 60% with the 12-week triple therapy for patients with eRVR and was 92% with an additional 12 weeks dual therapy. Since the 12-week telaprevir-based triple therapy seems to be “suboptimal,” the conclusions by the authors that a reinforced regimen of dual therapy could be an option in genotype 1-naïve patients who failed to achieve SVR after 12 weeks telaprevir-based triple therapy needs further consideration.
Chia-Yen Dai, M.D., Ph.D.1-3
Wan-Long Chuang, M.D., Ph.D.1,2
Ming-Lung Yu, M.D., Ph.D.1,2
1Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
2Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
3Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan