The relative efficacy of boceprevir and telaprevir in the treatment of hepatitis C virus genotype 1.
BACKGROUND
The licensing of direct-acting antivirals heralds a new era in the treatment of hepatitis C virus (HCV) genotype 1. We undertook a mixed treatment comparison to examine the relative efficacy among current treatments for HCV.


METHODS
A systematic literature review identified relevant studies. Meta-analyses were planned in treatment-naive and treatment-experienced patients. Study arms that evaluated telaprevir or boceprevir for unlicensed durations or without both pegylated interferon and ribavirin at standard doses were excluded. A Bayesian mixed treatment comparison model was fitted for each patient population.


RESULTS
Four hundred ninety-nine studies were identified. Ten met inclusion criteria. In the subgroup of prior treatment "relapsers," telaprevir had greater relative efficacy than boceprevir (odds ratio [OR], 2.61 [95% confidence interval {CI}, 1.24-5.52]). There were no statistically significant differences detected in relative efficacy for other patient categories. Treatment-naive patients: boceprevir vs standard of care (n = 1417) (OR, 3.06 [95% CI, 2.43-3.87]); telaprevir vs standard of care (n = 1309) (OR, 3.24 [95% CI, 2.56-4.10]); telaprevir vs boceprevir (OR, 1.06 [95% CI, 0.75-1.47]). Total treatment-experienced population: boceprevir vs standard of care (n = 604) (OR, 6.53 [95% CI, 4.20-10.32]); telaprevir vs standard of care (n = 891) (OR, 8.32 [5.69-12.36]); telaprevir vs boceprevir (OR, 1.27 [95% CI, .71-2.30]).


CONCLUSIONS
Telaprevir had greater relative efficacy than boceprevir in patients who had previously relapsed. There was insufficient evidence to detect a difference in treatment outcomes between the 2 agents in the overall population. It was not possible to determine relative efficacy for subgroups such as patients with cirrhosis owing to small numbers.
Departments of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland. kieranja@tcd.ie
Jennifer
J
Kieran
Susanne
S
Schmitz
Aisling
A
O'Leary
Cathal
C
Walsh
Colm
C
Bergin
Suzanne
S
Norris
Michael
M
Barry
D000998:Antiviral Agents / Q000627:therapeutic use*; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics*; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D009842:Oligopeptides / Q000627:therapeutic use*; D011392:Proline / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012008:Recurrence; D016896:Treatment Outcome
D000998:Antiviral Agents; D009842:Oligopeptides; C486464:telaprevir; C512204:N-(3-amino-1-(cyclobutylmethyl)-2,3-dioxopropyl)-3-(2-((((1,1-dimethylethyl)amino)carbonyl)amino)-3,3-dimethyl-1-oxobutyl)-6,6-dimethyl-3-azabicyclo(3.1.0)hexan-2-carboxamide; D011392:Proline