title: Telaprevir may induce adverse cutaneous reactions by a T cell immune-mediated mechanism.
abstract: The HCV protease inhibitor telaprevir associated with peginterferon-alpha and ribavirin, was widely used in the recent past as standard treatment in HCV genotype-1 infected patients. Telaprevir improves the sustained virology response rates, but at the same time increases the frequency of adverse cutaneous reactions. However, mechanisms through which telaprevir induces cutaneous lesions are not yet defined. A 50-year-old woman, affected by HCV genotype 1b, was admitted to our Department for a telaprevir-related severe cutaneous eruptions, eight weeks after starting a triple therapy (telaprevir associated with Peginterferon-alpha and ribavirin). Mechanisms of cutaneous reactions were investigated by skin tests with non-irritating concentrations of telaprevir and by activating in vitro T lymphocyte with different concentrations. Immediate and delayed responses to skin testing were negative, but the drug-induced lymphocytes activation was significantly higher as compared to patient's baseline values and to parallel results obtained in three healthy subjects (p < 0.05). In conclusion, adverse cutaneous reactions of our patient were caused by a telaprevir-induced T-cell dependent immune mechanism.
authors: Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
authors: Alessandro
authors: A
authors: Federico
authors: Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
authors: Ernesto
authors: E
authors: Aitella
authors: Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
authors: Dolores
authors: D
authors: Sgambato
authors: Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
authors: Alfonso
authors: A
authors: Savoia
authors: Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
authors: Fabio
authors: F
authors: De Bartolomeis
authors: Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
authors: Marcello
authors: M
authors: Dallio
authors: Department of Dermatology, Second University of Naples, Naples, Italy.
authors: Eleonora
authors: E
authors: Ruocco
authors: Department of Biochemistry, Biophysics and Pathology, Second University of Naples, Naples, Italy.
authors: Luciano
authors: L
authors: Pezone
authors: Department of Biochemistry, Biophysics and Pathology, Second University of Naples, Naples, Italy.
authors: Ciro
authors: C
authors: Abbondanza
authors: Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
authors: Carmela
authors: C
authors: Loguercio
authors: Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
authors: Corrado
authors: C
authors: Astarita
mesh_terms: D004279:DNA, Viral / Q000235:genetics; D003875:Drug Eruptions / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects*; D008875:Middle Aged; D009842:Oligopeptides / Q000009:adverse effects* / Q000627:therapeutic use; D013601:T-Lymphocytes / Q000187:drug effects / Q000276:immunology*
chemical_list: D004279:DNA, Viral; D009842:Oligopeptides; C486464:telaprevir