Telaprevir in treatment of recurrent hepatitis C infection in liver transplant recipients.
OBJECTIVE
Recurrent hepatitis C infection leads to accelerated graft loss in liver transplant recipients. Telaprevir offers a higher chance of cure in these patients. We sought to assess the effectiveness of telaprevir in treatment of hepatitis C in liver transplant recipients.


METHODS
We report a series of 17 patients who received telaprevir for recurrent hepatitis C virus infection. These patients were previous treatment failures including 10 null responders. All patients received pegylated interferon alpha 2a (180 μg/wk) and ribavirin (800 mg/d) for 1 year and telaprevir 750 mg every 8 hours for 12 weeks. The immunosuppressive regimen was not changed during therapy, but the dosages were modified based on serum levels of the drugs.


RESULTS
In an intention-to-treat analysis, the overall sustained virologic response 12 was 58%, with a relapse rate of 24%. Nine patients (52%) achieved extended rapid virologic response. Seven patients (77%) with extended rapid virologic response achieved sustained virologic response 12. Four patients (40%), who were previous null responders to interferon and ribavirin also achieved sustained virologic response 12. Anemia and ribavirin dosage reduction were common. Severe thrombocytopenia was seen in 2 patients resulting in discontinuation of therapy. A tacrolimus-based immunosuppressive regimen could be continued with close monitoring. During the initial 4 weeks of therapy, there were wide fluctuations in tacrolimus levels. However, after 4 weeks, tacrolimus could be dosed weekly maintaining a trough level of 3 to 10 ng/mL.


CONCLUSIONS
Telaprevir can be used effectively in liver transplant recipients receiving tacrolimus-based immunosuppression. Sustained virologic response 12 can be achieved in a significant number of these "difficult-to-treat" patients.
University of Tennessee Health Science Center, Memphis VA Medical Center, Memphis, TN, USA.
Satheesh
S
Nair
Bradford
B
Waters
D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016898:Interferon-alpha / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D012008:Recurrence; D012254:Ribavirin / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D009842:Oligopeptides; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C486464:telaprevir; C100416:peginterferon alfa-2a; D016559:Tacrolimus