title: Telaprevir-based triple therapy for hepatitis C null responders among living donor liver transplant recipients.
abstract: Telaprevir (TVR), a direct -acting protease inhibitor, was recently reported to improve treatment efficacy when used in combination with peg-interferon (PEG-IFN) and ribavirin (RBV) as triple therapy for HCV in non-transplant patients. The aim of the present study was to investigate the feasibility of TVR-based triple therapy among Japanese living donor liver transplant (LDLT) recipients who had been resistant to dual treatment with PEG-IFN and RBV. Among 133 HCV-positive LDLT recipients, 8 null responders during or after dual treatment with PEG-IFN and RBV were finally indicated for TVR-based triple therapy after treatment. All 8 patients had been resistant to dual treatment with PEG-IFN and RBV. While the cyclosporine trough level was well controlled with an 80% dose reduction during TVR administration, the end - of - treatment response rate was only 25% (2/8), with 63% (5/8) of patients developing anemia that required a blood transfusion and 50% (4/8) of patients developing leukopenia that required filgrastim. Dose reduction or treatment discontinuation was required in all cases. Based on the poor efficacy and the unacceptable high rate of cytopenic events, TVR-based triple therapy is not indicated for those resistant to dual treatment with PEG-IFN and RBV.
authors: Division of Artificial Organ and Transplantation, Department of Surgery, The University of Tokyo.
authors: Junichi
authors: J
authors: Kaneko
authors: Yasuhiko
authors: Y
authors: Sugawara
authors: Takamune
authors: T
authors: Yamaguchi
authors: Nobuhiro
authors: N
authors: Harada
authors: Nobuhisa
authors: N
authors: Akamatsu
authors: Takeaki
authors: T
authors: Ishizawa
authors: Taku
authors: T
authors: Aoki
authors: Yoshihiro
authors: Y
authors: Sakamoto
authors: Kiyoshi
authors: K
authors: Hasegawa
authors: Sumihito
authors: S
authors: Tamura
authors: Tomohiro
authors: T
authors: Tanaka
authors: Norihiro
authors: N
authors: Kokudo
mesh_terms: D000740:Anemia / Q000139:chemically induced; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D007564:Japan; D007970:Leukopenia / Q000139:chemically induced; D016031:Liver Transplantation; D008297:Male; D009842:Oligopeptides / Q000627:therapeutic use*; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use*; D066027:Transplant Recipients; D016896:Treatment Outcome
chemical_list: D016898:Interferon-alpha; D009842:Oligopeptides; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C486464:telaprevir; C100416:peginterferon alfa-2a