Liver Institute of Virginia, Bon Secours Health System, Richmond and Newport News, VA 23662, USA.
Liver Int. 2012 Feb;32 Suppl 1:54-60. doi: 10.1111/j.1478-3231.2011.02718.x.
Boceprevir and telaprevir are the first two protease inhibitors available for the treatment of patients infected with hepatitis C virus (HCV) genotype 1. A sustained virological response (SVR) of 70-80% is observed when either of these protease inhibitors is utilized with pegylated interferon (PEG-IFN) and ribavirin (RBV) in treatment naïve patients. Both agents are also highly effective in patients who failed to achieve a SVR during previous treatment with PEG-IFN/RBV. A rapid virological response (RVR) is observed in 56-60% of treatment naïve patients. Patients who achieve a RVR can be treated with a shorter course of therapy (24-28 weeks) and still achieve a SVR rate of 90% or higher. Patients who do not achieve a RVR, those with cirrhosis and certain prior non-responders should be treated for 48 weeks. Although the SVR rates observed with boceprevir and telaprevir are quite similar both globally and within sub-populations, the treatment algorithms for the two agents are unique. The decision of which protease inhibitor to use should assess several factors including the treatment scheme, duration of therapy, adverse event profile, cost and the likelihood of achieving a RVR. The latter is highly dependent upon IFN sensitivity and the IL28B genotype.
博赛泼维与特拉泼维是两种用于治疗 HCV 基因 1 型感染患者的蛋白酶抑制剂。在初治患者中，博赛泼维或特拉泼维与聚乙二醇干扰素（PEG-IFN）和利巴韦林（RBV）联合应用时，观察到 70-80%的持续病毒学应答（SVR）。这两种药物在先前 PEG-IFN/RBV 治疗未达到 SVR 的患者中也具有很高的疗效。初治患者中约 56-60%出现快速病毒学应答（RVR）。达到 RVR 的患者可接受更短疗程（24-28 周）治疗，仍可达到 90%或更高的 SVR 率。未达到 RVR 的患者、肝硬化患者和某些既往无应答者应接受 48 周治疗。尽管博赛泼维和特拉泼维的 SVR 率在全球和亚人群中都非常相似，但这两种药物的治疗方案是独特的。选择使用哪种蛋白酶抑制剂应评估多种因素，包括治疗方案、治疗持续时间、不良事件谱、成本以及达到 RVR 的可能性。后者高度依赖于 IFN 敏感性和 IL28B 基因型。
