Kawakami Yoshiiku, Suzuki Fumitaka, Karino Yoshiyasu, Toyota Joji, Kumada Hiromitsu, Chayama Kazuaki
Department of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
Antivir Ther. 2014;19(3):277-85. doi: 10.3851/IMP2706. Epub 2013 Nov 5.
The aim of this study is to explore the efficacy, safety and pharmacokinetics of 750 mg telaprevir (TVR) given at 8 or 12 h intervals during triple therapy with pegylated interferon-α2b (PEG-IFN) and ribavirin (RBV) for patients with chronic HCV infection.
A total of 52 patients with high viral loads of HCV genotype 1b who were expected to respond well to therapy (rs8099917 TT genotype or relapse to previous therapy) were randomly assigned to two groups who were given 750 mg TVR at either 8 h (q8h) or 12 h (q12h) intervals in combination with PEG-IFN and RBV for 12 weeks, followed by 12 additional weeks of treatment with PEG-IFN and RBV alone. The primary end point of the study was undetectable HCV RNA at 12 weeks after the end of treatment (sustained virological response [SVR]12).
SVR12 rates were 92.3% (24/26) for both q8h and q12h. The changes in mean log10 HCV RNA levels and viral response were also similar in q8h compared to q12h, whereas pharmacokinetic properties such as maximum plasma concentration, area under the concentration-time curve at 24 h and trough plasma concentration of TVR were slightly higher in q8h than in q12h (P>0.2). The frequency of TVR discontinuation due to anaemia or renal damage was significantly higher in q12h than in q8h (6/26 [23%] versus 0/20 [0%], respectively; P=0.02).
TVR given at 12 h intervals should be considered for patients with lower body weight, especially patients with prior relapse and with IL28B polymorphisms at rs8099917 TT (interferon-λ 4 ss469415590 polymorphism TT/TT) genotype in patients with genotype 1b HCV infection.
本研究旨在探讨在聚乙二醇化干扰素-α2b(PEG-IFN)和利巴韦林(RBV)三联疗法期间,每8小时或12小时给予750毫克特拉匹韦(TVR)对慢性丙型肝炎病毒(HCV)感染患者的疗效、安全性和药代动力学。
总共52例HCV基因1b型病毒载量高且预期对治疗反应良好(rs8099917 TT基因型或既往治疗复发)的患者被随机分为两组,分别每8小时(q8h)或每12小时(q12h)给予750毫克TVR,并联合PEG-IFN和RBV治疗12周,随后再单独使用PEG-IFN和RBV治疗12周。该研究的主要终点是治疗结束后12周时检测不到HCV RNA(持续病毒学应答[SVR]12)。
q8h组和q12h组的SVR12率均为92.3%(24/26)。与q12h组相比,q8h组平均log10 HCV RNA水平的变化和病毒应答也相似,而TVR的最大血浆浓度、24小时浓度-时间曲线下面积和血浆谷浓度等药代动力学特性在q8h组略高于q12h组(P>0.2)。q12h组因贫血或肾损害而停用TVR的频率显著高于q8h组(分别为6/26[23%]和0/20[0%];P=0.02)。
对于体重较低的患者,尤其是既往复发且HCV基因1b型感染患者中rs8099917 TT(干扰素-λ4 ss469415590多态性TT/TT)基因型且有IL28B多态性的患者,应考虑每12小时给予TVR。