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Keywords:

  • boceprevir;
  • hepatitis C;
  • meta-analysis;
  • protease inhibitors;
  • telaprevir

Summary

What is known and objective

Two NS3/4A protease inhibitors (PIs), telaprevir and boceprevir, were recently approved in the United States. The primary objective was to compare the efficacy and safety of triple therapies including either PI to dual therapy in patients with chronic hepatitis C genotype 1; the secondary objective was to conduct subgroup analyses to make comparisons based on patients' race.

Methods

Published and unpublished RCTs were selected if they: (i) had patients with chronic hepatitis C genotype 1, (ii) compared triple therapies (telaprevir or boceprevir + peg-interferon + ribavirin) and dual therapy (peg-interferon + ribavirin) and (iii) measured the outcome using sustained virologic response (SVR).

Results

A total of 4421 patients from 10 evaluated articles were included in the meta-analysis. Overall, triple therapy was significantly associated with a higher achievement of SVR than dual therapy: (i) telaprevir-based triple therapy in treatment-naïve patients (relative risk [RR] = 1·62; 95% confidence interval [CI], 1·47–1·78), (ii) telaprevir-based triple therapy in treatment-experienced patients (RR = 3·85; 95% CI, 3·03–4·90), (iii) boceprevir-based triple therapy in treatment-naïve patients (PR = 1·70; 95% CI, 1·56–1·86) and (iv) boceprevir-based triple therapy in treatment-experienced patients (RR = 2·98; 95% CI, 2·29–3·87). Although black and non-black patients demonstrated the higher rates of achieving SVR with triple therapy compared to dual therapy, the rates of SVR were still lower among black patients than among non-black patients. Patients on triple therapies had the significantly increased incidences of treatment discontinuation attributable to adverse events and serious adverse events when compared to dual therapy, especially treatment-experienced patients.

What is new and conclusions

Regarding achieving SVR, triple therapies including either PI are superior to dual therapy for both treatment-naïve and treatment-experienced patients.